Sanford Medical Center Mayville
42 6th Ave SE, Mayville, ND · Sanford Health · · NPI 1518061803
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 |
|---|---|---|---|---|
| T3 (triiodothyronine) free CPT 84481 | $90.40 | $113.00 | $25.90 – $96.30 | 15 |
| T3 (triiodothyronine) total CPT 84480 | $104.80 | $131.00 | $31.72 – $117.90 | 15 |
| T4 (thyroxine) free CPT 84439 | $47.20 | $59.00 | $14.28 – $53.10 | 15 |
| T4 (thyroxine) total CPT 84436 | $40.80 | $51.00 | $12.35 – $45.90 | 15 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $4.48 | $5.59 | $1.17 – $4.35 | 15 |
| Tacrolimus therapeutic drug level CPT 80197 | $91.20 | $114.00 | $27.60 – $102.60 | 15 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $236.00 | $295.00 | $71.42 – $265.50 | 15 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $261.60 | $327.00 | $79.17 – $294.30 | 15 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $250.40 | $313.00 | $60.53 – $225.00 | 15 |
| Tc-99m medronate HCPCS A9503 | $133.60 | $167.00 | $40.43 – $150.30 | 15 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $189.60 | $237.00 | $57.38 – $213.30 | 15 |
| T cells absolute cd 4 count CPT 86361 | $97.60 | $122.00 | $29.54 – $109.80 | 15 |
| T cells total count CPT 86359 | $156.00 | $195.00 | $47.21 – $175.50 | 15 |
| Telehealth original site facility fee HCPCS Q3014 | $80.80 | $101.00 | $24.45 – $90.90 | 15 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $6,011.74 | $7,514.67 | $1,819.30 – $6,763.20 | 15 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $28.92 | $36.14 | $8.66 – $32.21 | 15 |
| Test stress cardiovascular tracing only CPT 93017 | $525.60 | $657.00 | $159.06 – $591.30 | 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 | $76.80 | $96.00 | $23.24 – $86.40 | 15 |
| Therapeutic procd strg endur HCPCS G0237 | $117.60 | $147.00 | $35.59 – $132.30 | 15 |
| Therapy activity per session >= 45 minutes HCPCS G0176 | $536.00 | $670.00 | $162.21 – $603.00 | 15 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $117.60 | $147.00 | $60.50 – $132.30 | 15 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $109.60 | $137.00 | $63.25 – $123.30 | 15 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $92.80 | $116.00 | $28.08 – $104.40 | 15 |
| Therapy nutrition individual reassessment/intervention f2f w/patient each 15 minutes CPT 97803 | $74.40 | $93.00 | $22.52 – $83.70 | 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 | $31.05 | $38.81 | $8.77 – $32.59 | 15 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $240.00 | $300.00 | $72.63 – $270.00 | 15 |
| Thrombin time CPT 85670 | $40.00 | $50.00 | $9.93 – $36.90 | 15 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $58.40 | $73.00 | $10.41 – $38.70 | 15 |
| Thyroglobulin antibody CPT 86800 | $111.20 | $139.00 | $16.46 – $61.20 | 15 |
| Thyroid (TSH) Test CPT 84443 | $85.60 | $107.00 | $49.50 – $96.30 | 15 |
| Thyroid Ultrasound CPT 76536 | $480.00 | $600.00 | $145.26 – $540.00 | 15 |
| Tissue exam koh skin/hair/nails CPT 87220 | $28.80 | $36.00 | $8.72 – $32.40 | 15 |
| Tissue transglutaminase iga CPT 86364 | $42.40 | $53.00 | $12.83 – $47.70 | 15 |
| Tobramycin peak therapeutic drug level CPT 80200 | $60.80 | $76.00 | $18.40 – $68.40 | 15 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | $608.92 | $761.14 | $6.08 – $685.03 | 15 |
| Toe X-ray (both feet) CPT 73660 | $178.40 | $223.00 | $53.99 – $200.70 | 15 |
| Tomosynthesis breast diagnostic left HCPCS G0279 | $95.20 | $119.00 | $28.81 – $107.10 | 15 |
| Tomosynthesis breast screen bilateral CPT 77063 | $91.20 | $114.00 | $56.32 – $102.60 | 15 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | not published | not published | $46.57 – $46.57 | 1 |
| Toxoplasma antibody igg CPT 86777 | $84.80 | $106.00 | $25.66 – $95.40 | 15 |
| Toxoplasma antibody igm CPT 86778 | $74.40 | $93.00 | $22.52 – $83.70 | 15 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $130.40 | $163.00 | $39.46 – $146.70 | 15 |
| Transferrin CPT 84466 | $78.40 | $98.00 | $23.73 – $88.20 | 15 |
| Transvaginal Pelvic Ultrasound (not pregnancy) CPT 76830 | $523.20 | $654.00 | $158.33 – $588.60 | 15 |
| Transvaginal Pregnancy Ultrasound CPT 76817 | $364.80 | $456.00 | $110.40 – $410.40 | 15 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | not published | not published | $84.49 – $93.40 | 2 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | not published | not published | $29.15 – $29.15 | 1 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | not published | not published | $22.97 – $22.97 | 1 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $1,572.80 | $1,966.00 | $475.97 – $1,769.40 | 15 |
| Treat elbow fracture CPT 24620 | $2,125.60 | $2,657.00 | $643.26 – $2,391.30 | 15 |
| Treat fracture of radius CPT 25505 | $1,473.60 | $1,842.00 | $445.95 – $1,657.80 | 15 |
| Treat fracture of ulna CPT 25535 | $987.20 | $1,234.00 | $298.75 – $1,110.60 | 15 |
| Treat hip dislocation CPT 27252 | $2,131.20 | $2,664.00 | $644.95 – $2,397.60 | 15 |
| Treat knee fracture 27530 CPT 27530 | $737.60 | $922.00 | $223.22 – $829.80 | 15 |
| Treatment of ankle fracture 27786 CPT 27786 | $503.20 | $629.00 | $152.28 – $566.10 | 15 |
| Treatment of fibula fracture 27780 CPT 27780 | $474.40 | $593.00 | $143.57 – $533.70 | 15 |
| Treatment of heel fracture 28400 CPT 28400 | $469.60 | $587.00 | $142.11 – $528.30 | 15 |
| Treatment of thigh fracture CPT 27508 | $591.20 | $739.00 | $178.91 – $665.10 | 15 |
| Treatment of toe fracture 28510 CPT 28510 | $388.00 | $485.00 | $117.42 – $436.50 | 15 |
| Treat thigh fracture CPT 27230 | $612.80 | $766.00 | $185.45 – $689.40 | 15 |
| Treat thigh fracture CPT 27238 | $1,563.20 | $1,954.00 | $473.06 – $1,758.60 | 15 |
| Treat thigh fx growth plate CPT 27516 | $332.80 | $416.00 | $100.71 – $374.40 | 15 |
| Treat ulnar fracture CPT 24675 | $1,625.60 | $2,032.00 | $491.95 – $1,828.80 | 15 |
| Treponema pallidum antibody CPT 86780 | $62.40 | $78.00 | $9.93 – $36.90 | 15 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $32.27 | $40.33 | $8.46 – $31.46 | 15 |
| Triglycerides CPT 84478 | $36.00 | $45.00 | $9.20 – $34.20 | 15 |
| Trmt of fracture (femoral shaft) 27500 CPT 27500 | $796.00 | $995.00 | $240.89 – $895.50 | 15 |
| Troponin quantitative CPT 84484 | $80.00 | $100.00 | $24.21 – $90.00 | 15 |
| Tx closed hip disl traumatic without anes CPT 27250 | $649.60 | $812.00 | $196.59 – $730.80 | 15 |
| Tx closed tib shaft fx without manip CPT 27750 | $556.00 | $695.00 | $168.26 – $625.50 | 15 |
| Ua w/micro/comp poc CPT 81000 | $26.40 | $33.00 | $7.99 – $29.70 | 15 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | not published | not published | $70.76 – $70.76 | 1 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $408.00 | $510.00 | $123.47 – $459.00 | 15 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $576.00 | $720.00 | $174.31 – $648.00 | 15 |
| Ultrasound Guidance for a Needle Procedure CPT 76942 | $820.80 | $1,026.00 | $248.39 – $923.40 | 15 |
| Ultrasound joint complete left CPT 76881 | $624.80 | $781.00 | $189.08 – $702.90 | 15 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $373.60 | $467.00 | $113.06 – $420.30 | 15 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $420.80 | $526.00 | $127.34 – $473.40 | 15 |
| Ultrasound prostate/transrectal CPT 76872 | $628.00 | $785.00 | $190.05 – $706.50 | 15 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $196.00 | $245.00 | $59.31 – $220.50 | 15 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | $2,258.40 | $2,823.00 | $446.60 – $2,540.70 | 15 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $1,468.80 | $1,836.00 | $352.55 – $1,652.40 | 15 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $3,856.00 | $4,820.00 | $607.75 – $4,338.00 | 15 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $3,183.20 | $3,979.00 | $607.75 – $3,581.10 | 15 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $2,102.40 | $2,628.00 | $578.05 – $2,365.20 | 15 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $253.60 | $317.00 | $76.75 – $285.30 | 15 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $428.00 | $535.00 | $129.52 – $481.50 | 15 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $1,760.00 | $2,200.00 | $1,086.80 – $1,980.00 | 15 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $1,760.00 | $2,200.00 | $1,086.80 – $1,980.00 | 15 |
| Upper GI Barium X-ray (barium and gas) CPT 74246 | $868.00 | $1,085.00 | $262.68 – $976.50 | 15 |
| Upper GI Barium X-ray (barium only) CPT 74240 | $808.80 | $1,011.00 | $244.76 – $909.90 | 15 |
| Urea nitrogen CPT 84520 | $27.20 | $34.00 | $8.23 – $30.60 | 15 |
| Urea nitrogen 24 hour urine CPT 84540 | $51.20 | $64.00 | $4.36 – $16.20 | 15 |
| Uric acid blood CPT 84550 | $32.00 | $40.00 | $9.68 – $36.00 | 15 |
| Uric acid urine CPT 84560 | $43.20 | $54.00 | $3.87 – $14.40 | 15 |
| Urinalysis microscopic only CPT 81015 | $20.80 | $26.00 | $6.29 – $23.40 | 15 |
| Urinalysis qual/semiquant excpt ia CPT 81005 | $16.00 | $20.00 | $4.84 – $18.00 | 15 |
| Urinalysis (with microscopy) CPT 81001 | $36.00 | $45.00 | $10.89 – $40.50 | 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.