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 |
|---|---|---|---|---|
| Inj, donanemab-azbt, 2 mg HCPCS J0175 | not published | not published | $4.16 – $4.16 | 1 |
| Injection, burosumab-twza 1m HCPCS J0584 | not published | not published | $478.43 – $478.43 | 1 |
| Injection, casimersen, 10 mg HCPCS J1426 | not published | not published | $160.00 – $160.00 | 1 |
| Injection, daratumumab 10 mg HCPCS J9145 | not published | not published | $78.01 – $78.01 | 1 |
| Injection, edaravone, 1 mg HCPCS J1301 | not published | not published | $22.58 – $22.58 | 1 |
| Injection, renflexis HCPCS Q5104 | $539.71 | $674.63 | $27.68 – $607.17 | 15 |
| Injection, ruconest HCPCS J0596 | not published | not published | $35.36 – $35.36 | 1 |
| Injection(s) anesthetic agent(s) and/or steroid other peripheral nerve/branch (both sides) CPT 64450 | $992.80 | $1,241.00 | $300.45 – $1,116.90 | 15 |
| Injection(s) trigger point(s) single/multiple 1 or 2 muscle(s) CPT 20552 | $609.60 | $762.00 | $184.48 – $685.80 | 15 |
| Injection therapeutic/prophylactic/diagnostic each addl sequential IV push same substance/drug CPT 96376 | $112.00 | $140.00 | $33.60 – $126.00 | 15 |
| Inj efgart-alfa 2mg hya-qvfc HCPCS J9334 | not published | not published | $33.75 – $33.75 | 1 |
| Inj eflapegrastim-xnst 0.1mg HCPCS J1449 | not published | not published | $23.18 – $23.18 | 1 |
| Inj, eteplirsen, 10 mg HCPCS J1428 | not published | not published | $160.00 – $160.00 | 1 |
| Inj, evinacumab-dgnb, 5mg HCPCS J1305 | not published | not published | $189.83 – $189.83 | 1 |
| Inj. fe derisomaltose 10 mg HCPCS J1437 | $2,444.76 | $3,055.95 | $739.85 – $2,750.36 | 15 |
| Inj givosiran 0.5 mg HCPCS J0223 | not published | not published | $114.26 – $114.26 | 1 |
| Inj golodirsen 10 mg HCPCS J1429 | not published | not published | $160.00 – $160.00 | 1 |
| Inj., haegarda 10 units HCPCS J0599 | not published | not published | $14.43 – $14.43 | 1 |
| Inj. herceptin hylecta, 10mg HCPCS J9356 | not published | not published | $76.42 – $76.42 | 1 |
| Inj herzuma 10 mg HCPCS Q5113 | not published | not published | $72.41 – $72.41 | 1 |
| Inj., ibalizumab-uiyk, 10 mg HCPCS J1746 | not published | not published | $78.53 – $78.53 | 1 |
| Inj, imm glob bivigam, 500mg HCPCS J1556 | not published | not published | $76.58 – $76.58 | 1 |
| Inj. inebilizumab-cdon, 1 mg HCPCS J1823 | not published | not published | $493.54 – $493.54 | 1 |
| Inj ivig privigen 500 mg HCPCS J1459 | $1,732.16 | $2,165.20 | $48.29 – $547.92 | 15 |
| Inj., lanadelumab-flyo, 1 mg HCPCS J0593 | not published | not published | $89.54 – $89.54 | 1 |
| Inj, lecanemab-irmb, 1 mg HCPCS J0174 | not published | not published | $1.35 – $1.35 | 1 |
| Inj, lidocaine w epinephrine HCPCS J2004 | $28.49 | $35.61 | $0.42 – $1.58 | 15 |
| Inj. lumasiran, 0.5 mg HCPCS J0224 | not published | not published | $323.89 – $323.89 | 1 |
| Inj, meropenem (b. braun) HCPCS J2184 | $119.25 | $149.06 | $34.88 – $129.66 | 15 |
| Inj ogivri 10 mg HCPCS Q5114 | not published | not published | $64.87 – $64.87 | 1 |
| Inj olipudase alfa-rpcp 1mg HCPCS J0218 | not published | not published | $389.78 – $389.78 | 1 |
| Inj ontruzant 10 mg HCPCS Q5112 | not published | not published | $40.92 – $40.92 | 1 |
| Inj, panzyga, 500 mg HCPCS J1576 | not published | not published | $68.74 – $68.74 | 1 |
| Inj., patisiran, 0.1 mg HCPCS J0222 | not published | not published | $100.73 – $100.73 | 1 |
| Inj pegfilgrastim-bmez 0.5mg HCPCS Q5120 | $2,486.82 | $3,108.52 | $327.13 – $2,797.67 | 15 |
| Inj pozelimab-bbfg, 1 mg HCPCS J9376 | not published | not published | $90.87 – $90.87 | 1 |
| Inj sebelipase alfa 1 mg HCPCS J2840 | not published | not published | $510.50 – $510.50 | 1 |
| Inj, sutimlimab-jome, 10 mg HCPCS J1302 | not published | not published | $18.49 – $18.49 | 1 |
| Inj, taliglucerace alfa 10 u HCPCS J3060 | not published | not published | $43.39 – $43.39 | 1 |
| Inj. teprotumumab-trbw 10 mg HCPCS J3241 | not published | not published | $350.36 – $350.36 | 1 |
| Inj., tildrakizumab, 1 mg HCPCS J3245 | not published | not published | $138.49 – $138.49 | 1 |
| Inj, tislelizumab-jsgr HCPCS J9329 | not published | not published | $66.09 – $66.09 | 1 |
| Inj, tofidence, 1 mg HCPCS Q5133 | not published | not published | $5.55 – $5.55 | 1 |
| Inj, tyenne, 1 mg HCPCS Q5135 | not published | not published | $5.15 – $5.15 | 1 |
| Inj, vancomycin hcl (mylan) HCPCS J3371 | $28.92 | $36.14 | $8.75 – $32.53 | 15 |
| Inj velmanase alfa-tycv 1 mg HCPCS J0217 | not published | not published | $450.34 – $450.34 | 1 |
| Inj., vestronidase alfa-vjbk HCPCS J3397 | not published | not published | $263.70 – $263.70 | 1 |
| Inj. viltolarsen HCPCS J1427 | not published | not published | $56.40 – $56.40 | 1 |
| Inj. xembify, 100 mg HCPCS J1558 | not published | not published | $14.59 – $14.59 | 1 |
| Insertion catheter bladder non indwelling CPT 51701 | $230.40 | $288.00 | $69.72 – $259.20 | 15 |
| Insitu hybridization manual CPT 88368 | $318.40 | $398.00 | $96.36 – $358.20 | 15 |
| In situ hybridization per specimen initial single probe stain CPT 88365 | $338.40 | $423.00 | $102.41 – $380.70 | 15 |
| Insulin total CPT 83525 | $84.80 | $106.00 | $25.66 – $95.40 | 15 |
| Intrinsic factor antibody CPT 86340 | $56.80 | $71.00 | $17.19 – $63.90 | 15 |
| Intubation endotracheal emergency procedure CPT 31500 | $483.20 | $604.00 | $146.23 – $543.60 | 15 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $140.00 | $175.00 | $42.37 – $157.50 | 15 |
| Ipratropium bromide non-comp HCPCS J7644 | $3.40 | $4.25 | $1.03 – $3.83 | 15 |
| Iron CPT 83540 | $32.00 | $40.00 | $9.68 – $36.00 | 15 |
| Iron binding capacity CPT 83550 | $46.40 | $58.00 | $14.04 – $52.20 | 15 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $20.04 | $25.05 | $4.94 – $18.37 | 15 |
| Irradiation of blood product each unit reference CPT 86945 | $117.60 | $147.00 | $35.59 – $132.30 | 15 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $188.80 | $236.00 | $48.42 – $180.00 | 15 |
| IV Fluids (each additional hour) CPT 96361 | $102.40 | $128.00 | $30.99 – $115.20 | 15 |
| IV Fluids (first hour) CPT 96360 | $372.00 | $465.00 | $112.58 – $418.50 | 15 |
| Ivig non-lyophilized, nos HCPCS J1599 | not published | not published | $156.45 – $156.45 | 1 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $174.40 | $218.00 | $47.20 – $196.20 | 15 |
| IV Medicine Infusion (additional drug) CPT 96367 | $174.40 | $218.00 | $52.78 – $196.20 | 15 |
| IV Medicine Infusion (each additional hour) CPT 96366 | $121.60 | $152.00 | $36.80 – $136.80 | 15 |
| IV Medicine Infusion (first hour) CPT 96365 | $447.20 | $559.00 | $135.33 – $503.10 | 15 |
| IV Push Injection (each additional drug) CPT 96375 | $168.00 | $210.00 | $36.80 – $189.00 | 15 |
| IV Push Injection (first drug) CPT 96374 | $295.20 | $369.00 | $88.80 – $332.10 | 15 |
| Jaw Joint (TMJ) X-ray (both sides, open and closed) CPT 70330 | $448.00 | $560.00 | $135.58 – $504.00 | 15 |
| Jaw (Mandible) X-ray (complete) CPT 70110 | $439.20 | $549.00 | $132.91 – $494.10 | 15 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $51.20 | $64.00 | $15.49 – $57.60 | 15 |
| Ketorolac (Toradol) Pain Shot, 15 mg HCPCS J1885 | $29.44 | $36.79 | $7.97 – $29.65 | 15 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $615.20 | $769.00 | $186.17 – $692.10 | 15 |
| Kidney (Retroperitoneal) Ultrasound (limited) CPT 76775 | $476.80 | $596.00 | $144.29 – $536.40 | 15 |
| Knee MRI (with and without contrast) CPT 73723 | $3,511.20 | $4,389.00 | $607.75 – $3,950.10 | 15 |
| Knee MRI (with contrast) CPT 73722 | not published | not published | $611.05 – $611.05 | 1 |
| Knee MRI (without contrast) CPT 73721 | $2,511.20 | $3,139.00 | $578.05 – $2,825.10 | 15 |
| Knee X-ray CPT 73564 | $460.00 | $575.00 | $139.21 – $517.50 | 15 |
| Knee X-ray (1 to 2 views, both knees) CPT 73560 | $188.00 | $235.00 | $56.89 – $211.50 | 15 |
| Knee X-ray (3 views, both knees) CPT 73562 | $233.60 | $292.00 | $70.69 – $262.80 | 15 |
| Knee X-ray (standing, both knees) CPT 73565 | $212.00 | $265.00 | $64.16 – $238.50 | 15 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $27.93 | $34.91 | $1.64 – $6.09 | 15 |
| Lactate dehydrogenase (ldh) CPT 83615 | $44.80 | $56.00 | $13.56 – $50.40 | 15 |
| Lactated ringers intravenous solution HCPCS J7120 | $60.00 | $75.00 | $18.16 – $67.50 | 15 |
| Lactic acid CPT 83605 | $57.60 | $72.00 | $17.43 – $64.80 | 15 |
| Lactoferrin fecal qualitative CPT 83630 | $111.20 | $139.00 | $33.65 – $125.10 | 15 |
| Large Joint Injection or Fluid Draw (both sides) CPT 20610 | $627.20 | $784.00 | $189.81 – $705.60 | 15 |
| Laronidase injection HCPCS J1931 | not published | not published | $39.41 – $39.41 | 1 |
| Lead capillary CPT 83655 | $62.40 | $78.00 | $8.96 – $33.30 | 15 |
| Leg CT Scan (with contrast, both legs) CPT 73701 | $1,984.80 | $2,481.00 | $446.60 – $2,232.90 | 15 |
| Leg CT Scan (without contrast, both legs) CPT 73700 | $1,235.20 | $1,544.00 | $352.55 – $1,389.60 | 15 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $928.00 | $1,160.00 | $280.84 – $1,044.00 | 15 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $594.40 | $743.00 | $174.55 – $648.90 | 15 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $508.41 | $635.51 | $153.86 – $571.96 | 15 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $112.08 | $140.10 | $8.13 – $30.24 | 15 |
| Levetiracetam therapeutic drug level CPT 80177 | $68.80 | $86.00 | $20.82 – $77.40 | 15 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $71.64 | $89.55 | $21.38 – $79.47 | 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.