Sanford Clear Lake Medical Center
701 3rd Ave S, Clear Lake, SD · Sanford Health · · NPI 1851305296
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 |
|---|---|---|---|---|
| 5% dextrose and 0.45% saline HCPCS S5010 | $86.40 | $108.00 | $55.40 – $97.20 | 17 |
| 88334 ap bill cytologic exam each additional site CPT 88334 | $60.00 | $75.00 | $38.48 – $67.50 | 17 |
| Abatacept (with maltose) 250 mg intravenous solution HCPCS J0129 | $2,341.48 | $2,926.84 | $44.25 – $2,634.16 | 17 |
| Abdominal and Pelvic Blood Vessel Ultrasound (complete) CPT 93975 | $1,353.60 | $1,692.00 | $868.00 – $1,522.80 | 17 |
| Abdominal and Pelvic Blood Vessel Ultrasound (limited) CPT 93976 | $984.00 | $1,230.00 | $630.99 – $1,107.00 | 17 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $3,052.80 | $3,816.00 | $893.20 – $3,434.40 | 17 |
| Abdominal CT scan (with contrast) CPT 74160 | $2,666.40 | $3,333.00 | $893.20 – $2,999.70 | 17 |
| Abdominal CT scan (without contrast) CPT 74150 | $2,214.40 | $2,768.00 | $705.10 – $2,491.20 | 17 |
| Abdominal MRI (with and without contrast) CPT 74183 | $4,211.20 | $5,264.00 | $1,215.50 – $4,737.60 | 17 |
| Abdominal MRI (with contrast) CPT 74182 | $3,372.80 | $4,216.00 | $1,215.50 – $3,794.40 | 17 |
| Abdominal MRI (without contrast) CPT 74181 | $2,994.40 | $3,743.00 | $1,156.10 – $3,368.70 | 17 |
| Abdominal paracentesis w/image guidance CPT 49083 | $1,892.80 | $2,366.00 | $1,213.76 – $2,129.40 | 17 |
| Abdominal Ultrasound (complete) CPT 76700 | $1,109.60 | $1,387.00 | $711.53 – $1,248.30 | 17 |
| Abdominal Ultrasound (limited) CPT 76705 | $764.80 | $956.00 | $490.43 – $860.40 | 17 |
| Abdominal X-ray (2 views) CPT 74019 | $387.20 | $484.00 | $248.29 – $435.60 | 17 |
| Abdominal X-ray (single view) CPT 74018 | $307.20 | $384.00 | $196.99 – $345.60 | 17 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $109.70 | $137.12 | $70.34 – $123.41 | 17 |
| Acetaminophen level CPT 80143 | $53.60 | $67.00 | $34.37 – $60.30 | 17 |
| Acetone qualitative CPT 82009 | $48.00 | $60.00 | $30.78 – $54.00 | 17 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $218.60 | $273.24 | $65.87 – $115.56 | 17 |
| Acetylcysteine non-comp unit HCPCS J7608 | $43.42 | $54.27 | $27.84 – $48.84 | 17 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $50.40 | $63.00 | $32.32 – $56.70 | 17 |
| Acute hepatitis panel CPT 80074 | $316.00 | $395.00 | $202.64 – $355.50 | 17 |
| Acyclovir 400 mg tablet HCPCS J8499 | $16.40 | $20.49 | $0.77 – $1.35 | 17 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $63.21 | $79.01 | $39.67 – $69.59 | 17 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $62.10 | $77.62 | $39.39 – $69.10 | 17 |
| Adh-sendout CPT 84588 | $240.80 | $301.00 | $123.12 – $216.00 | 17 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $26.08 | $32.60 | $12.38 – $21.73 | 17 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $281.60 | $352.00 | $67.20 – $316.80 | 17 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | not published | not published | $153.60 – $153.60 | 1 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $828.80 | $1,036.00 | $313.60 – $932.40 | 17 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $370.40 | $463.00 | $237.52 – $416.70 | 17 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $239.20 | $299.00 | $85.60 – $269.10 | 17 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $312.00 | $390.00 | $173.60 – $351.00 | 17 |
| _afb id by dna probe rflx ast CPT 87149 | $80.00 | $100.00 | $51.30 – $90.00 | 17 |
| _afb org id by sequencing rflx ast-sendout CPT 87153 | $308.00 | $385.00 | $197.51 – $346.50 | 17 |
| Agalsidase beta 35 mg intravenous solution HCPCS J0180 | not published | not published | $227.74 – $227.74 | 1 |
| Albumin (human), 25%, 50ml HCPCS P9047 | $175.03 | $218.78 | $62.47 – $109.59 | 17 |
| Albumin (microalbumin) 24 hour urine quantitative CPT 82043 | $109.60 | $137.00 | $70.28 – $123.30 | 17 |
| Albumin serum plasma or whole blood CPT 82040 | $40.00 | $50.00 | $25.65 – $45.00 | 17 |
| Albuterol ipratrop non-comp HCPCS J7620 | $4.82 | $6.02 | $2.66 – $4.67 | 17 |
| Albuterol non-comp con HCPCS J7611 | $18.37 | $22.96 | $11.78 – $20.66 | 17 |
| Albuterol non-comp unit HCPCS J7613 | $4.16 | $5.20 | $2.59 – $4.54 | 17 |
| Alcohol (ethanol) any specimen except urine/breath CPT 82077 | $104.80 | $131.00 | $67.20 – $117.90 | 17 |
| Alemtuzumab 12 mg/1.2 ml intravenous solution HCPCS J0202 | not published | not published | $2,381.81 – $2,381.81 | 1 |
| Alkaline phosphatase CPT 84075 | $62.40 | $78.00 | $18.47 – $32.40 | 17 |
| Allergen alpha lactalbumin ige CPT 86008 | $52.00 | $65.00 | $33.35 – $58.50 | 17 |
| Allergen egg white ige CPT 86003 | $54.40 | $68.00 | $16.42 – $28.80 | 17 |
| Alpha-1-proteinase inhibitor (human) 1,000 mg (+/-) IV solution HCPCS J0256 | not published | not published | $5.03 – $5.03 | 1 |
| Alpha-fetoprotein tumor marker CPT 82105 | $133.60 | $167.00 | $85.67 – $150.30 | 17 |
| Alteplase 100 mg infusion from pyxis vial HCPCS J2997 | $12,473.57 | $15,591.96 | $164.03 – $287.77 | 17 |
| Alt/sgpt CPT 84460 | $41.60 | $52.00 | $26.68 – $46.80 | 17 |
| Aminolevulinic acid delta CPT 82135 | $104.00 | $130.00 | $66.69 – $117.00 | 17 |
| Aminophylline 25 mg/ml intravenous solution (wrapper) HCPCS J0280 | $69.26 | $86.57 | $44.41 – $77.91 | 17 |
| Amiodarone 150 mg/100 ml (1.5 mg/ml) in dextrose, iso-osmotic IV HCPCS J0283 | $150.55 | $188.18 | $89.51 – $157.03 | 17 |
| Amiodarone 50 mg/ml intravenous solution HCPCS J0282 | $61.30 | $76.62 | $39.12 – $68.63 | 17 |
| Ammonia CPT 82140 | $168.80 | $211.00 | $108.24 – $189.90 | 17 |
| Ampicillin 1 gram solution for injection HCPCS J0290 | $62.03 | $77.53 | $39.22 – $68.81 | 17 |
| Ampicillin-sulbactam 1.5 gram solution for injection HCPCS J0295 | $63.96 | $79.95 | $39.79 – $69.80 | 17 |
| Amylase CPT 82150 | $83.20 | $104.00 | $44.12 – $77.40 | 17 |
| Ana ds-dna CPT 86226 | $204.80 | $256.00 | $131.33 – $230.40 | 17 |
| Analysis gene f2 20210g>a variant CPT 81240 | $400.80 | $501.00 | $257.01 – $450.90 | 17 |
| Analysis gene f5 leiden variant CPT 81241 | $265.60 | $332.00 | $123.12 – $216.00 | 17 |
| Anca screen with reflex to titer -quest CPT 86021 | $163.20 | $204.00 | $81.57 – $143.10 | 17 |
| Angiotensin ii 0.5 mg/ml soln 1 ml vial HCPCS J3490 | $86.40 | $108.00 | $0.90 – $1.58 | 17 |
| Ankle X-ray CPT 73610 | $376.80 | $471.00 | $241.62 – $423.90 | 17 |
| Ankle X-ray (2 views, both ankles) CPT 73600 | $308.00 | $385.00 | $197.51 – $346.50 | 17 |
| Anodyne therapy charges pt CPT 97026 | $53.60 | $67.00 | $34.37 – $60.30 | 17 |
| Anora (draw only) CPT 99001 | $50.40 | $63.00 | $31.29 – $54.90 | 17 |
| Antibody bacterium, not elsewhere specified CPT 86609 | $32.00 | $40.00 | $20.52 – $36.00 | 17 |
| Antibody elution rbc reference CPT 86860 | $129.60 | $162.00 | $83.11 – $145.80 | 17 |
| Antibody htlv/hiv confirm test CPT 86689 | $224.80 | $281.00 | $144.15 – $252.90 | 17 |
| Antibody identification platelet antibodies heparin-pf4 igg CPT 86022 | $224.00 | $280.00 | $143.64 – $252.00 | 17 |
| Antibody id rbc panel CPT 86870 | $258.40 | $323.00 | $165.70 – $290.70 | 17 |
| Antibody screen rbc CPT 86850 | $116.00 | $145.00 | $74.39 – $130.50 | 17 |
| Antineutrophil cytoplasmic antibody screen each antibody CPT 86036 | $56.00 | $70.00 | $35.91 – $63.00 | 17 |
| Antineutrophil cytoplasmic antibody titer each antibody CPT 86037 | $66.40 | $83.00 | $42.58 – $74.70 | 17 |
| Antinuclear antibodies CPT 86038 | $89.60 | $112.00 | $57.46 – $100.80 | 17 |
| Antinuclear antibodies titer CPT 86039 | $58.40 | $73.00 | $37.45 – $65.70 | 17 |
| Antistreptolysin o titer CPT 86060 | $86.40 | $108.00 | $55.40 – $97.20 | 17 |
| Antithrombin iii activity CPT 85300 | $214.40 | $268.00 | $137.48 – $241.20 | 17 |
| Aortic Aneurysm Screening Ultrasound CPT 76706 | $565.60 | $707.00 | $362.69 – $636.30 | 17 |
| Application lower leg splint 29515 CPT 29515 | $365.60 | $457.00 | $234.44 – $411.30 | 17 |
| Appl modality 1/> areas paraffin bath 97018 CPT 97018 | $94.40 | $118.00 | $60.53 – $106.20 | 17 |
| Appl modality 1/> areas vasopneumatic devices 97016 CPT 97016 | $80.80 | $101.00 | $51.81 – $90.90 | 17 |
| Aqaprn-4 antb flo cytmtry ea CPT 86053 | $190.40 | $238.00 | $122.09 – $214.20 | 17 |
| Aqua therapy w/exercise/ea 15 min 97113 CPT 97113 | $128.00 | $160.00 | $82.08 – $144.00 | 17 |
| Arm CT Scan (with contrast, both arms) CPT 73201 | not published | not published | $1,215.50 – $1,215.50 | 1 |
| Arm CT Scan (without contrast, both arms) CPT 73200 | $2,022.40 | $2,528.00 | $705.10 – $2,275.20 | 17 |
| Arm or Leg Ultrasound (limited, left side) CPT 76882 | $601.60 | $752.00 | $385.78 – $676.80 | 17 |
| Arthrocentesis/aspiration/injection intermediate joint/bursa without ultrasound guidance right CPT 20605 | $591.20 | $739.00 | $379.11 – $665.10 | 17 |
| Aspirate/inj ganglion cyst 20612 CPT 20612 | $365.60 | $457.00 | $234.44 – $411.30 | 17 |
| Assay of salicylate CPT 80179 | $93.60 | $117.00 | $60.02 – $105.30 | 17 |
| Assess aphasia/interp/rpt/per hr 96105 CPT 96105 | $391.20 | $489.00 | $250.86 – $440.10 | 17 |
| Assessment leukocyte fecal qualitative/semiquantitative CPT 89055 | $54.40 | $68.00 | $34.88 – $61.20 | 17 |
| Ast/sgot CPT 84450 | $53.60 | $67.00 | $34.37 – $60.30 | 17 |
| Atezolizumab 60 mg/ml intravenous solution (wrapper) HCPCS J9022 | not published | not published | $103.32 – $103.32 | 1 |
| Atropine 0.1 mg/ml injection syringe HCPCS J0461 | $60.71 | $75.88 | $38.54 – $67.62 | 17 |
| Automated diff wbc count CPT 85004 | $36.80 | $46.00 | $23.60 – $41.40 | 17 |
| Avelumab 20 mg/ml intravenous solution HCPCS J9023 | not published | not published | $114.04 – $114.04 | 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.