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 |
|---|---|---|---|---|
| ER Visit (level 3) CPT 99283 | $565.60 | $707.00 | $171.16 – $636.30 | 15 |
| ER Visit (level 4) CPT 99284 | $957.60 | $1,197.00 | $289.79 – $1,077.30 | 15 |
| ER Visit (level 5, high severity) CPT 99285 | $1,411.20 | $1,764.00 | $427.06 – $1,587.60 | 15 |
| Esmolol 2,500 mg/250 ml (10 mg/ml) IV wrapper osm only HCPCS J1805 | $252.48 | $315.60 | $8.74 – $32.49 | 15 |
| Esophagoscopy flex biopsy CPT 43202 | $2,240.00 | $2,800.00 | $677.88 – $2,520.00 | 15 |
| Esoph egd dilation <30 mm CPT 43249 | $2,396.80 | $2,996.00 | $958.10 – $2,696.40 | 15 |
| Established Patient Office Visit (level 1) CPT 99211 | $125.60 | $157.00 | $10.41 – $38.70 | 15 |
| Estradiol total CPT 82670 | $138.40 | $173.00 | $41.88 – $155.70 | 15 |
| Eval aud rehab status/first hr 92626 CPT 92626 | $300.80 | $376.00 | $91.03 – $338.40 | 15 |
| Eval/fit voice prosthesis iii, st CPT 92607 | $455.20 | $569.00 | $137.75 – $512.10 | 15 |
| Evaluation of speech fluency 92521 CPT 92521 | $361.60 | $452.00 | $109.43 – $406.80 | 15 |
| Excision benign lesion trunk/arms/legs 1.1 - 2.0 cm CPT 11402 | $960.00 | $1,200.00 | $290.52 – $1,080.00 | 15 |
| Ext ecg>48hr<7d scan a/r CPT 93243 | $221.60 | $277.00 | $67.06 – $249.30 | 15 |
| Ext ecg>7d<15d scan a/r CPT 93247 | $331.20 | $414.00 | $100.23 – $372.60 | 15 |
| External newborn metabolic screening panel HCPCS S3620 | $235.20 | $294.00 | $63.91 – $237.60 | 15 |
| Extractable nuclear antigen/antibody any method each antibody centromere CPT 86235 | $120.00 | $150.00 | $17.19 – $63.90 | 15 |
| Eye Socket (Orbit) X-ray CPT 70200 | $500.00 | $625.00 | $151.31 – $562.50 | 15 |
| Eye Socket, Pituitary or Ear CT Scan (with and without contrast) CPT 70482 | $2,324.00 | $2,905.00 | $446.60 – $2,614.50 | 15 |
| Eye Socket, Pituitary or Ear CT Scan (with contrast) CPT 70481 | $2,100.00 | $2,625.00 | $446.60 – $2,362.50 | 15 |
| Eye Socket, Pituitary or Ear CT Scan (without contrast) CPT 70480 | $1,929.60 | $2,412.00 | $352.55 – $2,170.80 | 15 |
| Face, Eye Socket and Neck MRI (with and without contrast) CPT 70543 | $3,656.00 | $4,570.00 | $607.75 – $4,113.00 | 15 |
| Face, Eye Socket and Neck MRI (without contrast) CPT 70540 | $2,616.00 | $3,270.00 | $578.05 – $2,943.00 | 15 |
| Facial Bones X-ray (1 to 2 views) CPT 70140 | $328.00 | $410.00 | $99.26 – $369.00 | 15 |
| Facial Bones X-ray (complete) CPT 70150 | $412.80 | $516.00 | $124.92 – $464.40 | 15 |
| Factor ix CPT 85250 | $94.40 | $118.00 | $28.57 – $106.20 | 15 |
| Factor viii CPT 85240 | $70.40 | $88.00 | $21.30 – $79.20 | 15 |
| Family therapy without pt 50min 90846 CPT 90846 | $644.00 | $805.00 | $194.89 – $724.50 | 15 |
| Family therapy with patient 50 min 90847 CPT 90847 | $676.00 | $845.00 | $204.57 – $760.50 | 15 |
| Famotidine in ns IV syringe 0.4 mg/ml (neo/ped) - cnr HCPCS J1308 | $26.52 | $33.14 | $8.00 – $29.75 | 15 |
| Fat/lipids feces qualitative CPT 82705 | $28.80 | $36.00 | $8.72 – $32.40 | 15 |
| Felbamate (felbatol(r)) - sendout CPT 80167 | $71.20 | $89.00 | $21.55 – $80.10 | 15 |
| Fentanyl citrate (pf) 50 mcg/ml injection for compounding (wrapper) HCPCS J3010 | $27.61 | $34.51 | $7.91 – $29.41 | 15 |
| Ferric carboxymaltose 50 mg iron/ml intravenous solution HCPCS J1439 | $675.09 | $843.86 | $204.30 – $759.47 | 15 |
| Ferritin CPT 82728 | $76.80 | $96.00 | $23.24 – $86.40 | 15 |
| Ferumoxytol 510 mg/17 ml (30 mg/ml) intravenous solution HCPCS Q0138 | $434.28 | $542.85 | $131.42 – $488.57 | 15 |
| Ferumoxytol, esrd use HCPCS Q0139 | $434.28 | $542.85 | $131.42 – $488.57 | 15 |
| Fetal biophys profile w/nst 76818 CPT 76818 | $376.00 | $470.00 | $113.79 – $423.00 | 15 |
| Fetal fibronectin CPT 82731 | $352.80 | $441.00 | $106.77 – $396.90 | 15 |
| Fetal hemoglobin (kleihauer betke) CPT 85460 | $224.00 | $280.00 | $67.79 – $252.00 | 15 |
| Fetal non stress test CPT 59025 | $458.40 | $573.00 | $138.72 – $515.70 | 15 |
| #_fet/norfentcnfrmur CPT 80354 | $74.40 | $93.00 | $22.52 – $83.70 | 15 |
| Fibrin degradation d dimer quantitative CPT 85379 | $79.20 | $99.00 | $23.97 – $89.10 | 15 |
| Fibrin degrade semiquant CPT 85378 | $88.00 | $110.00 | $26.63 – $99.00 | 15 |
| Fibrinogen activity CPT 85384 | $48.00 | $60.00 | $14.53 – $54.00 | 15 |
| Fibrinolysins/coagulopathy screen interpretation/report CPT 85390 | $86.40 | $108.00 | $26.15 – $97.20 | 15 |
| Fibrinolytic plasminogen CPT 85415 | $161.60 | $202.00 | $48.90 – $181.80 | 15 |
| Filgrastim in d5w IV syringe 20 mcg/ml (neo) - cnr HCPCS J1442 | $570.05 | $712.56 | $95.73 – $355.86 | 15 |
| Filgrastim-sndz 300 mcg/0.5 ml injection syringe HCPCS Q5101 | $326.60 | $408.24 | $98.83 – $367.42 | 15 |
| Finger X-ray (both hands) CPT 73140 | $176.00 | $220.00 | $53.26 – $198.00 | 15 |
| Flebogamma injection HCPCS J1572 | not published | not published | $52.94 – $52.94 | 1 |
| Flecainide (tambocor)-sendout CPT 80181 | $86.40 | $108.00 | $26.15 – $97.20 | 15 |
| Flexible Sigmoidoscopy CPT 45330 | $1,753.60 | $2,192.00 | $530.68 – $1,972.80 | 15 |
| Flow cytometry marker each additional CPT 88185 | $116.00 | $145.00 | $33.41 – $124.20 | 15 |
| Flow cytometry one marker technical component CPT 88184 | $188.00 | $235.00 | $51.08 – $189.90 | 15 |
| Fluconazole 200 mg/100 ml in sod. chloride (iso) intravenous piggyback HCPCS J1450 | $72.32 | $90.40 | $21.89 – $81.36 | 15 |
| Fluorescent antibody titer dna CPT 86256 | $56.80 | $71.00 | $17.19 – $63.90 | 15 |
| Fmri brain by phys/psych CPT 70555 | not published | not published | $578.05 – $578.05 | 1 |
| Fmri brain by tech CPT 70554 | not published | not published | $578.05 – $578.05 | 1 |
| Folic acid CPT 82746 | $83.20 | $104.00 | $25.18 – $93.60 | 15 |
| Folic acid 5 mg/ml injection solution HCPCS J1808 | $0.52 | $0.65 | $0.15 – $0.54 | 15 |
| Foot X-ray CPT 73630 | $211.20 | $264.00 | $63.91 – $237.60 | 15 |
| Foot X-ray (2 views, both feet) CPT 73620 | $207.20 | $259.00 | $62.70 – $233.10 | 15 |
| Forearm X-ray (both sides) CPT 73090 | $220.00 | $275.00 | $66.58 – $247.50 | 15 |
| Fosaprepitant 150 mg intravenous powder for solution HCPCS J1453 | $464.61 | $580.76 | $140.60 – $522.68 | 15 |
| Fosphenytoin 50 mg pe/ml injection (wrapper) HCPCS Q2009 | $27.60 | $34.49 | $8.35 – $31.04 | 15 |
| _fragile x methylation-sendout CPT 81244 | $120.80 | $151.00 | $36.56 – $135.90 | 15 |
| Fresh frozen plasma frozen within 8 hours of collection each unit HCPCS P9017 | $197.60 | $247.00 | $59.80 – $222.30 | 15 |
| Fructosamine glycated protein CPT 82985 | $53.60 | $67.00 | $16.22 – $60.30 | 15 |
| Ftl cgen abnor four anal CPT 81511 | $371.20 | $464.00 | $112.33 – $417.60 | 15 |
| Full Spine X-ray (Scoliosis Survey) CPT 72082 | $263.20 | $329.00 | $79.65 – $296.10 | 15 |
| Furosemide 10 mg/ml injection solution HCPCS J1938 | $27.48 | $34.34 | $4.01 – $14.91 | 15 |
| Gadobutrol 1 mmol/ml intravenous solution (wrapper) HCPCS A9585 | $102.00 | $127.50 | $30.87 – $114.75 | 15 |
| Gadoxetate 0.25 mmol/ml (181.43 mg/ml) intravenous solution HCPCS A9581 | $136.00 | $170.00 | $41.16 – $153.00 | 15 |
| Galactose transferase test CPT 82776 | $34.40 | $43.00 | $10.41 – $38.70 | 15 |
| Gallbladder Function Scan (HIDA with Medication) CPT 78227 | $1,983.20 | $2,479.00 | $600.17 – $2,231.10 | 15 |
| Galsulfase injection HCPCS J1458 | not published | not published | $493.88 – $493.88 | 1 |
| Gamma globulin > 10 cc inj HCPCS J1560 | not published | not published | $507.94 – $507.94 | 1 |
| Gamma globulin 1 cc inj HCPCS J1460 | not published | not published | $50.78 – $50.78 | 1 |
| Gammaglobulin iga CPT 82784 | $69.60 | $87.00 | $9.20 – $34.20 | 15 |
| Gammaglobulin ige CPT 82785 | $93.60 | $117.00 | $23.00 – $85.50 | 15 |
| Gamma glutamyltransferase CPT 82977 | $54.40 | $68.00 | $16.46 – $61.20 | 15 |
| Gammaplex injection HCPCS J1557 | not published | not published | $59.03 – $59.03 | 1 |
| Gamunex-c/gammaked HCPCS J1561 | $4,550.40 | $5,688.00 | $49.73 – $977.00 | 15 |
| General health panel CPT 80050 | $221.60 | $277.00 | $67.06 – $249.30 | 15 |
| Gentamicin 10 mg/ml liquid compound - enteral use only HCPCS J1580 | $27.55 | $34.43 | $7.97 – $29.65 | 15 |
| Gentamicin peak therapeutic drug level CPT 80170 | $85.60 | $107.00 | $25.90 – $96.30 | 15 |
| Ghs abscess perianal iandd CPT 46050 | $2,070.40 | $2,588.00 | $626.55 – $2,329.20 | 15 |
| Ghs antibodies (torch) igm CPT 86694 | $77.60 | $97.00 | $23.48 – $87.30 | 15 |
| Ghs chemo >8 hrs CPT 96416 | not published | not published | $308.80 – $308.80 | 1 |
| Ghs chemo infusion >8 hrs CPT 96425 | not published | not published | $407.20 – $407.20 | 1 |
| Ghs chemo IV push, ea addtl CPT 96411 | not published | not published | $132.00 – $132.00 | 1 |
| Ghs closd tx interphalang jt disloc w/ma CPT 26770 | $587.20 | $734.00 | $177.70 – $660.60 | 15 |
| Ghs closed reduction ankle dislocation CPT 27840 | $680.80 | $851.00 | $206.03 – $765.90 | 15 |
| Ghs clsd red med malleolus fx without manip CPT 27760 | $539.20 | $674.00 | $163.18 – $606.60 | 15 |
| Ghs cl tx knee disl; wo anesth CPT 27550 | $496.80 | $621.00 | $150.34 – $558.90 | 15 |
| Ghs cl tx metacarpophal disloc without anes CPT 26700 | $604.80 | $756.00 | $183.03 – $680.40 | 15 |
| Ghs community re-entry 15 minutes CPT 97537 | $92.80 | $116.00 | $28.08 – $104.40 | 15 |
| Ghs conjunctiva foreign body-embed bil CPT 65210 | $532.80 | $666.00 | $161.24 – $599.40 | 15 |
| Ghs conjunctiva foreign body-superf bil CPT 65205 | $341.60 | $427.00 | $103.38 – $384.30 | 15 |
| Ghs corneal fb without slit lamp bilat CPT 65220 | $586.40 | $733.00 | $177.46 – $659.70 | 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.