Sanford Sheldon Medical Center
118 N 7th Ave, Sheldon, IA · Sanford Health · · NPI 1841200623
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| Sinus CT scan (with contrast) CPT 70487 | $2,528.00 | $3,160.00 | $900.60 – $2,844.00 | 15 |
| Sinus CT scan (without contrast) CPT 70486 | $2,112.00 | $2,640.00 | $752.40 – $2,376.00 | 15 |
| Sinus X-ray (complete) CPT 70220 | $383.20 | $479.00 | $136.52 – $431.10 | 15 |
| Sinus X-ray (limited) CPT 70210 | $268.00 | $335.00 | $95.48 – $301.50 | 15 |
| Sirolimus, oral HCPCS J7520 | $47.68 | $59.60 | $3.98 – $12.56 | 15 |
| Skin Biopsy CPT 11102 | $413.60 | $517.00 | $147.35 – $465.30 | 15 |
| Skull X-ray (1 to 3 views) CPT 70250 | $390.40 | $488.00 | $139.08 – $439.20 | 15 |
| Skull X-ray (complete) CPT 70260 | $416.80 | $521.00 | $148.49 – $468.90 | 15 |
| Sleep Study (Polysomnography) CPT 95810 | $4,216.00 | $5,270.00 | $1,501.95 – $4,743.00 | 15 |
| Sling pelv split sam med HCPCS L0621 | $278.40 | $348.00 | $99.18 – $313.20 | 15 |
| Sling suprapubic suburetheral HCPCS C1771 | $3,114.40 | $3,893.00 | $826.22 – $2,609.10 | 15 |
| Slp eval non-spch gen comm dev CPT 92605 | $399.20 | $499.00 | $142.22 – $449.10 | 15 |
| Slp pure tone screening CPT 92551 | $61.60 | $77.00 | $21.95 – $69.30 | 15 |
| Slp ther svc non-spch gen CPT 92606 | $303.20 | $379.00 | $108.02 – $341.10 | 15 |
| Small Bowel Barium X-ray (Follow-Through) CPT 74250 | $924.00 | $1,155.00 | $329.18 – $1,039.50 | 15 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $72.80 | $91.00 | $25.94 – $81.90 | 15 |
| Smear gram stain CPT 87205 | $38.40 | $48.00 | $13.68 – $43.20 | 15 |
| Smear nasal eosinophil CPT 89190 | $45.60 | $57.00 | $16.25 – $51.30 | 15 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $71.20 | $89.00 | $25.37 – $80.10 | 15 |
| Smear wet mount CPT 87210 | $53.60 | $67.00 | $19.10 – $60.30 | 15 |
| Sodium 24 hour urine CPT 84300 | $43.20 | $54.00 | $15.39 – $48.60 | 15 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $40.00 | $50.00 | $14.25 – $45.00 | 15 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $48.00 | $60.00 | $7.13 – $22.50 | 15 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $48.00 | $60.00 | $17.10 – $54.00 | 15 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $5.25 | $6.56 | $1.71 – $5.40 | 15 |
| Sodium serum/plasma/whole blood CPT 84295 | $36.00 | $45.00 | $12.83 – $40.50 | 15 |
| Sodium thiosulfate 12.5 gram/50 ml (250 mg/ml) intravenous solution HCPCS J0209 | $91.86 | $114.82 | $32.72 – $103.34 | 15 |
| Specimen fat stain CPT 89125 | $74.40 | $93.00 | $26.51 – $83.70 | 15 |
| Speech and Language Evaluation (comprehensive) CPT 92523 | $484.80 | $606.00 | $172.71 – $545.40 | 15 |
| Speech Therapy Session (one-on-one) CPT 92507 | $311.20 | $389.00 | $110.87 – $350.10 | 15 |
| Spine X-ray (single view, one level) CPT 72020 | $323.20 | $404.00 | $115.14 – $363.60 | 15 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $88.00 | $110.00 | $25.37 – $80.10 | 15 |
| Splint finger frog med HCPCS L3927 | $23.20 | $29.00 | $7.98 – $25.20 | 15 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $168.80 | $211.00 | $45.03 – $142.20 | 15 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $388.00 | $485.00 | $138.23 – $436.50 | 15 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $388.00 | $485.00 | $138.23 – $436.50 | 15 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $240.00 | $300.00 | $85.50 – $270.00 | 15 |
| Sterile water/saline, 500 ml HCPCS A4217 | $61.65 | $77.06 | $14.25 – $45.00 | 15 |
| St evaluate speech sound production CPT 92522 | $371.20 | $464.00 | $132.24 – $417.60 | 15 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $510.40 | $638.00 | $181.83 – $574.20 | 15 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $1,791.20 | $2,239.00 | $638.12 – $2,015.10 | 15 |
| Strep b dna amp probe CPT 87653 | $232.80 | $291.00 | $82.94 – $261.90 | 15 |
| Stress test pulmonary CPT 94618 | $418.40 | $523.00 | $149.06 – $470.70 | 15 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $76.24 | $95.30 | $22.57 – $71.27 | 15 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $69.13 | $86.41 | $22.35 – $70.59 | 15 |
| Support clav 29.6-40.5in med HCPCS L3650 | $40.00 | $50.00 | $14.25 – $45.00 | 15 |
| Surgical pathology level 1 gross examination only CPT 88300 | $72.00 | $90.00 | $25.65 – $81.00 | 15 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $153.60 | $192.00 | $54.72 – $172.80 | 15 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $213.60 | $267.00 | $76.10 – $240.30 | 15 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $359.20 | $449.00 | $127.97 – $404.10 | 15 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $1,271.20 | $1,589.00 | $452.87 – $1,430.10 | 15 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $1,754.40 | $2,193.00 | $625.01 – $1,973.70 | 15 |
| Susceptibility agar dilution per agent CPT 87181 | $41.60 | $52.00 | $14.82 – $46.80 | 15 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $56.80 | $71.00 | $20.24 – $63.90 | 15 |
| Susceptibility mic per plate CPT 87186 | $157.60 | $197.00 | $22.23 – $70.20 | 15 |
| Swallowing Evaluation (Bedside) CPT 92610 | $372.00 | $465.00 | $132.53 – $418.50 | 15 |
| Swallowing Therapy Session CPT 92526 | $288.00 | $360.00 | $102.60 – $324.00 | 15 |
| Synvisc or synvisc-one HCPCS J7325 | $712.61 | $890.76 | $253.87 – $801.68 | 15 |
| T3 (triiodothyronine) free CPT 84481 | $152.80 | $191.00 | $54.44 – $171.90 | 15 |
| T3 (triiodothyronine) total CPT 84480 | $114.40 | $143.00 | $40.76 – $128.70 | 15 |
| T4 (thyroxine) free CPT 84439 | $93.60 | $117.00 | $33.06 – $104.40 | 15 |
| T4 (thyroxine) total CPT 84436 | $52.80 | $66.00 | $18.81 – $59.40 | 15 |
| Tacrol envarsus ex rel oral HCPCS J7503 | $10.76 | $13.44 | $3.83 – $12.10 | 15 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $4.49 | $5.61 | $0.43 – $1.35 | 15 |
| Tacrolimus therapeutic drug level CPT 80197 | $180.80 | $226.00 | $64.41 – $203.40 | 15 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $346.40 | $433.00 | $123.41 – $389.70 | 15 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $298.40 | $373.00 | $106.31 – $335.70 | 15 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $273.60 | $342.00 | $97.47 – $307.80 | 15 |
| Tc-99m labeled rbc HCPCS A9560 | $428.00 | $535.00 | $152.48 – $481.50 | 15 |
| Tc-99m maa HCPCS A9540 | $936.80 | $1,171.00 | $333.74 – $1,053.90 | 15 |
| Tc-99m mebrofenin HCPCS A9537 | $178.40 | $223.00 | $63.56 – $200.70 | 15 |
| Tc-99m medronate HCPCS A9503 | $133.60 | $167.00 | $47.60 – $150.30 | 15 |
| Tc-99m mertiatide HCPCS A9562 | $756.00 | $945.00 | $269.33 – $850.50 | 15 |
| Tc-99m oxidronate HCPCS A9561 | $168.00 | $210.00 | $59.85 – $189.00 | 15 |
| Tc-99m pentetate dtpa HCPCS A9539 | $388.80 | $486.00 | $138.51 – $437.40 | 15 |
| Tc-99m pentetate dtpa aerosol HCPCS A9567 | $388.80 | $486.00 | $138.51 – $437.40 | 15 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $108.00 | $135.00 | $38.48 – $121.50 | 15 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $352.00 | $440.00 | $125.40 – $396.00 | 15 |
| Tc-99m sulfur colloid HCPCS A9541 | $308.00 | $385.00 | $109.73 – $346.50 | 15 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $120.00 | $150.00 | $42.75 – $135.00 | 15 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $324.00 | $405.00 | $115.43 – $364.50 | 15 |
| T cells absolute cd 4 count CPT 86361 | $167.20 | $209.00 | $59.57 – $188.10 | 15 |
| T cells total count CPT 86359 | $259.20 | $324.00 | $92.34 – $291.60 | 15 |
| Telavancin injection HCPCS J3095 | $819.60 | $1,024.50 | $291.98 – $922.05 | 15 |
| Telehealth original site facility fee HCPCS Q3014 | $68.00 | $85.00 | $24.23 – $76.50 | 15 |
| Temsirolimus 30 mg/3 ml (10 mg/ml) (first dilution) intravenous soln HCPCS J9330 | $1,831.93 | $2,289.91 | $652.62 – $2,060.92 | 15 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $12,366.50 | $15,458.12 | $3,461.90 – $10,932.30 | 15 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $74.61 | $93.26 | $21.71 – $68.57 | 15 |
| Test stress cardiovascular tracing only CPT 93017 | $1,168.80 | $1,461.00 | $416.39 – $1,314.90 | 15 |
| Tetanus immune globulin inj HCPCS J1670 | $660.69 | $825.86 | $213.27 – $673.47 | 15 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $18.45 – $18.45 | 1 |
| Theophylline therapeutic drug level CPT 80198 | $115.20 | $144.00 | $41.04 – $129.60 | 15 |
| Therapeutic procd strg endur HCPCS G0237 | $120.80 | $151.00 | $43.04 – $135.90 | 15 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $128.00 | $160.00 | $45.60 – $144.00 | 15 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $132.80 | $166.00 | $47.31 – $149.40 | 15 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $65.60 | $82.00 | $23.37 – $73.80 | 15 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $60.00 | $75.00 | $21.38 – $67.50 | 15 |
| Ther/proph/diag inj ia CPT 96373 | not published | not published | $44.80 – $44.80 | 1 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $66.35 | $82.93 | $22.46 – $70.93 | 15 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $317.60 | $397.00 | $113.15 – $357.30 | 15 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.