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 |
|---|---|---|---|---|
| Hepatitis a antibody igm CPT 86709 | $60.00 | $75.00 | $18.16 – $67.50 | 15 |
| Hepatitis b core antibody igm CPT 86705 | $67.20 | $84.00 | $20.34 – $75.60 | 15 |
| Hepatitis b core antibody total CPT 86704 | $66.40 | $83.00 | $20.09 – $74.70 | 15 |
| Hepatitis b surface antibody CPT 86706 | $63.20 | $79.00 | $19.13 – $71.10 | 15 |
| Hepatitis c antibody CPT 86803 | $81.60 | $102.00 | $24.69 – $91.80 | 15 |
| Herpes simplex type 1 antibody igg CPT 86695 | $71.20 | $89.00 | $21.55 – $80.10 | 15 |
| Herpes simplex type 2 antibody igg CPT 86696 | $103.20 | $129.00 | $31.23 – $116.10 | 15 |
| Heterophile antibodies screening CPT 86308 | $43.20 | $54.00 | $10.89 – $40.50 | 15 |
| Hip and Pelvis X-ray (2 views, both hips) CPT 73521 | $423.20 | $529.00 | $128.07 – $476.10 | 15 |
| Hip and Pelvis X-ray (3 to 4 views, both hips) CPT 73522 | $331.20 | $414.00 | $100.23 – $372.60 | 15 |
| Hip and Pelvis X-ray (single view, left side) CPT 73501 | $185.60 | $232.00 | $56.17 – $208.80 | 15 |
| Hip X-ray CPT 73502 | $248.00 | $310.00 | $75.05 – $279.00 | 15 |
| Histamine CPT 83088 | $130.40 | $163.00 | $23.97 – $89.10 | 15 |
| Histochemical stains add-on CPT 88314 | $187.20 | $234.00 | $56.65 – $210.60 | 15 |
| Hizentra injection HCPCS J1559 | not published | not published | $13.46 – $13.46 | 1 |
| Hla class i high defin qual CPT 86832 | $804.00 | $1,005.00 | $243.31 – $904.50 | 15 |
| Hla class ii high defin qual CPT 86833 | $808.80 | $1,011.00 | $244.76 – $909.90 | 15 |
| Hla ii typing ag equiv lr CPT 81375 | $294.40 | $368.00 | $89.09 – $331.20 | 15 |
| Hla i low res one antigen equiv ea CPT 81374 | $152.00 | $190.00 | $46.00 – $171.00 | 15 |
| Hla i typing complete lr CPT 81372 | $788.00 | $985.00 | $216.20 – $803.70 | 15 |
| Home sleep test/type 2 porta HCPCS G0398 | $474.40 | $593.00 | $143.57 – $533.70 | 15 |
| Homocysteine CPT 83090 | $96.00 | $120.00 | $29.05 – $108.00 | 15 |
| Homogenization tissue CPT 87176 | $39.20 | $49.00 | $11.86 – $44.10 | 15 |
| Hopd mntl hlt, 15-29 min HCPCS C7900 | $488.00 | $610.00 | $147.68 – $549.00 | 15 |
| Hopd mntl hlt, 30-60 min HCPCS C7901 | $640.80 | $801.00 | $193.92 – $720.90 | 15 |
| Hopd mntl hlt, grp HCPCS C7903 | $605.60 | $757.00 | $183.27 – $681.30 | 15 |
| H pylori (c-13) breath CPT 83013 | $308.00 | $385.00 | $93.21 – $346.50 | 15 |
| Hyaluronidase 200 units/ml inj HCPCS J3471 | $115.87 | $144.83 | $35.06 – $130.35 | 15 |
| Hyaluronidase, human recombinant 150 unit/ml injection solution HCPCS J3473 | $98.87 | $123.58 | $29.92 – $111.22 | 15 |
| Hydralazine 20 mg/ml injection solution HCPCS J0360 | $29.28 | $36.60 | $8.36 – $31.10 | 15 |
| Hydrocortisone in ns IV syringe 1 mg/ml (neo/ped) - cnr HCPCS J1720 | $66.75 | $83.43 | $9.73 – $36.16 | 15 |
| Hydromorphone 0.2 mg/ml in 0.9% nacl IV pca opioid naive - 4 hr dose limit (wrapper) HCPCS J1171 | $13.66 | $17.07 | $4.03 – $14.98 | 15 |
| Hyqvia 100mg immuneglobulin HCPCS J1575 | not published | not published | $17.81 – $17.81 | 1 |
| Icatibant injection HCPCS J1744 | not published | not published | $93.19 – $93.19 | 1 |
| Idursulfase injection HCPCS J1743 | not published | not published | $548.06 – $548.06 | 1 |
| Ihc/icc per specimen each additional single antibody stain CPT 88341 | $213.60 | $267.00 | $64.64 – $240.30 | 15 |
| Ihc/icc per specimen each multiplex antibody stain CPT 88344 | $338.40 | $423.00 | $102.41 – $380.70 | 15 |
| Ihc/icc per specimen initial single antibody stain CPT 88342 | $238.40 | $298.00 | $72.15 – $268.20 | 15 |
| Immune globulin, gamma (igg) (10 %)-gly-iga over 50 mcg/ml injection solution HCPCS J1569 | $2,525.52 | $3,156.90 | $50.63 – $554.54 | 15 |
| Immune globulin, gamma (igg) 10 gram-gly-gluc-iga 0 to 50 mcg/ml IV solution HCPCS J1566 | not published | not published | $83.74 – $83.74 | 1 |
| Immune globulin, gamma (igg) (10 %)-malt-iga over 50 mcg/ml intravenous solution HCPCS J1568 | not published | not published | $49.91 – $49.91 | 1 |
| Immunoassay tumor antigen quantitative ca 125 CPT 86304 | $101.60 | $127.00 | $30.75 – $114.30 | 15 |
| Immunoassay tumor antigen quantitative ca 19-9 CPT 86301 | $101.60 | $127.00 | $30.75 – $114.30 | 15 |
| Immunodiff gel qual ea antigen/ab CPT 86331 | $90.40 | $113.00 | $9.20 – $34.20 | 15 |
| Immunofixation electrophoresis serum CPT 86334 | $141.60 | $177.00 | $37.04 – $137.70 | 15 |
| Immunofluorescence per specimen each additional single antibody stain CPT 88350 | $215.20 | $269.00 | $65.12 – $242.10 | 15 |
| Immunofluorescence per specimen initial single antibody stain CPT 88346 | $288.00 | $360.00 | $87.16 – $324.00 | 15 |
| Imuglucerase injection HCPCS J1786 | not published | not published | $44.44 – $44.44 | 1 |
| Incision & drainage hematoma/seroma/fluid collection CPT 10140 | $2,047.20 | $2,559.00 | $619.53 – $2,303.10 | 15 |
| Inf agt nucleic acid human papillomavirus separately reported high-risk types pooled result(s) CPT 87626 | $131.20 | $164.00 | $39.70 – $147.60 | 15 |
| Infect ag ia optc obs influenza CPT 87804 | $69.60 | $87.00 | $18.40 – $68.40 | 15 |
| Infect ag na hpv high-risk types CPT 87624 | $131.20 | $164.00 | $29.29 – $108.90 | 15 |
| Infect ag na influenza r/amp 1st 2 types CPT 87502 | $248.80 | $311.00 | $75.29 – $279.90 | 15 |
| Infect ag na orthopoxvirus amp prb each CPT 87593 | $144.00 | $180.00 | $43.58 – $162.00 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step clostridium difficile toxin CPT 87324 | $80.80 | $101.00 | $24.45 – $90.90 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step cryptosporidium CPT 87328 | $72.00 | $90.00 | $20.82 – $77.40 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step giardia CPT 87329 | $72.00 | $90.00 | $20.82 – $77.40 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step helicobacter pylori stool CPT 87338 | $164.80 | $206.00 | $49.63 – $184.50 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn CPT 87340 | $60.80 | $76.00 | $18.40 – $68.40 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step hepatitis b surface agn neutralization CPT 87341 | $67.20 | $84.00 | $20.34 – $75.60 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step hiv-1 antigen(s) hiv-1&2 antibodies CPT 87389 | $116.80 | $146.00 | $35.35 – $131.40 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step legionella urine CPT 87449 | $169.60 | $212.00 | $9.20 – $34.20 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step rotavirus CPT 87425 | $59.20 | $74.00 | $17.92 – $66.60 | 15 |
| Infectious agent antigen immunoassay ql/sq multi step shiga-like toxin CPT 87427 | $63.20 | $79.00 | $19.13 – $71.10 | 15 |
| Infectious agent nucleic acid amplified probe CPT 87798 | $203.20 | $254.00 | $26.15 – $97.20 | 15 |
| Infectious agent nucleic acid amplified probe chlamydia trachomatis CPT 87491 | $171.20 | $214.00 | $34.62 – $128.70 | 15 |
| Infectious agent nucleic acid amplified probe clostridium difficile toxin gene(s) CPT 87493 | $192.00 | $240.00 | $58.10 – $216.00 | 15 |
| Infectious agent nucleic acid amplified probe hsv-1 CPT 87529 | $179.20 | $224.00 | $26.15 – $97.20 | 15 |
| Infectious agent nucleic acid amplified probe methicillin resistant staphylococcus aureus CPT 87641 | $170.40 | $213.00 | $50.36 – $187.20 | 15 |
| Infectious agent nucleic acid amplified probe mycobacteria tuberculosis CPT 87556 | $208.00 | $260.00 | $62.95 – $234.00 | 15 |
| Infectious agent nucleic acid amplified probe neisseria gonorrhoeae CPT 87591 | $171.20 | $214.00 | $26.15 – $97.20 | 15 |
| Infectious agent nucleic acid amplified probe sars-cov-2/covid-19 CPT 87635 | $124.80 | $156.00 | $66.00 – $140.40 | 15 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a & b CPT 87636 | $349.60 | $437.00 | $105.80 – $393.30 | 15 |
| Infectious agent nucleic acid amplified probe sars-cov-2/inf a&b/rsv CPT 87637 | $460.80 | $576.00 | $139.45 – $518.40 | 15 |
| Infectious agent nucleic acid amplified probe streptococcus group a CPT 87651 | $105.60 | $132.00 | $31.96 – $118.80 | 15 |
| Infectious agent nucleic acid amplified probe trichomonas vaginalis CPT 87661 | $153.60 | $192.00 | $46.48 – $172.80 | 15 |
| Infectious agent nucleic acid amp probe multiplex chlamydia trachomatis neisseria gonorrhoeae CPT 87494 | $342.40 | $428.00 | $60.77 – $225.90 | 15 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 12-25 targets CPT 87507 | $1,227.20 | $1,534.00 | $371.38 – $1,380.60 | 15 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 3-5 targets CPT 87505 | $312.80 | $391.00 | $94.66 – $351.90 | 15 |
| Infectious agent nucleic acid multiplex amplified probe gi pathogen 6-11 targets CPT 87506 | $745.60 | $932.00 | $210.87 – $783.90 | 15 |
| Infectious agent nucleic acid quantification bk virus CPT 87799 | $179.20 | $224.00 | $31.23 – $116.10 | 15 |
| Infectious agent nucleic acid quantification hepatitis b CPT 87517 | $100.00 | $125.00 | $30.26 – $112.50 | 15 |
| Infectious agent nucleic acid quantification hepatitis c CPT 87522 | $129.60 | $162.00 | $39.22 – $145.80 | 15 |
| Infectious agent nucleic acid quantification hiv-1 CPT 87536 | $415.20 | $519.00 | $125.65 – $467.10 | 15 |
| Infectious agent nucleic acid respiratory virus multiplex amplified probe 3-5 targets CPT 87631 | $348.00 | $435.00 | $105.31 – $391.50 | 15 |
| Infliximab 100 mg intravenous solution HCPCS J1745 | $1,448.98 | $1,811.22 | $32.81 – $659.60 | 15 |
| Infliximab-axxq 100 mg intravenous solution HCPCS Q5121 | not published | not published | $21.68 – $21.68 | 1 |
| Infliximab-dyyb 100 mg intravenous solution HCPCS Q5103 | not published | not published | $13.88 – $13.88 | 1 |
| Inj acetaminophen -fresenius HCPCS J0134 | $90.88 | $113.60 | $27.50 – $102.24 | 15 |
| Inj, adzynma, 10 iu HCPCS J7171 | not published | not published | $35.25 – $35.25 | 1 |
| Inj anifrolumab-fnia 1mg HCPCS J0491 | not published | not published | $17.63 – $17.63 | 1 |
| Inj. asceniv HCPCS J1554 | not published | not published | $500.66 – $500.66 | 1 |
| Inj aval alfa-nqpt 4mg HCPCS J0219 | not published | not published | $79.24 – $79.24 | 1 |
| Inj., benralizumab, 1 mg HCPCS J0517 | not published | not published | $170.48 – $170.48 | 1 |
| Inj, cefepime hcl (b braun) HCPCS J0703 | $116.89 | $146.11 | $34.02 – $126.49 | 15 |
| Inj., cerliponase alfa 1 mg HCPCS J0567 | not published | not published | $116.40 – $116.40 | 1 |
| Inj, cipaglucosidase, 5 mg HCPCS J1203 | not published | not published | $89.74 – $89.74 | 1 |
| Inj, clindamycin (baxter) HCPCS J0737 | $90.72 | $113.40 | $27.45 – $102.06 | 15 |
| Inj cutaquig 100 mg HCPCS J1551 | not published | not published | $14.78 – $14.78 | 1 |
| Inj cuvitru, 100 mg HCPCS J1555 | not published | not published | $17.14 – $17.14 | 1 |
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.