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 |
|---|---|---|---|---|
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | $89.23 | $111.53 | $44.73 – $78.48 | 17 |
| Olanzapine long-acting inj HCPCS J2358 | $1,407.84 | $1,759.80 | $643.49 – $1,128.92 | 17 |
| Omalizumab 150 mg/ml subcutaneous syringe (wrapper) HCPCS J2357 | not published | not published | $39.04 – $39.04 | 1 |
| Onco (ovar) five proteins CPT 81503 | $2,188.80 | $2,736.00 | $1,403.57 – $2,462.40 | 17 |
| Ondansetron 4 mg s0119 HCPCS S0119 | $4.46 | $5.57 | $0.77 – $1.35 | 17 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $60.56 | $75.70 | $38.68 – $67.85 | 17 |
| Osmolality blood CPT 83930 | $80.00 | $100.00 | $51.30 – $90.00 | 17 |
| Osmolality urine CPT 83935 | $80.00 | $100.00 | $51.30 – $90.00 | 17 |
| Ot re-evaluation patient/family CPT 97168 | $232.80 | $291.00 | $149.28 – $261.90 | 17 |
| Ot therapeutic interventions cognitive skills direct patient contact each additional 15 minutes CPT 97130 | $121.60 | $152.00 | $77.98 – $136.80 | 17 |
| Ot therapeutic interventions cognitive skills direct patient contact initial 15 minutes CPT 97129 | $144.00 | $180.00 | $92.34 – $162.00 | 17 |
| Oxytocin 10 unit/ml injection solution HCPCS J2590 | $60.73 | $75.91 | $38.94 – $68.32 | 17 |
| Paliperidone 117 mg/0.75 ml inj HCPCS J2426 | $1,749.04 | $2,186.30 | $1,121.57 – $1,967.67 | 17 |
| Pantoprazole in ns IV syringe 0.8 mg/ml (neo/ped) - cnr HCPCS J2470 | $62.79 | $78.48 | $39.02 – $68.45 | 17 |
| Parathormone (pth) intact CPT 83970 | $230.40 | $288.00 | $147.74 – $259.20 | 17 |
| Paring/cutting benign hyperkeratotic lesion single CPT 11055 | $267.20 | $334.00 | $171.34 – $300.60 | 17 |
| Pegfilgrastim 6 mg/0.6 ml (deliverable) wearable subcutaneous injector HCPCS J2506 | $7,933.38 | $9,916.72 | $31.73 – $8,925.05 | 17 |
| Pegfilgrastim-apgf 6 mg/0.6 ml subcutaneous syringe HCPCS Q5122 | not published | not published | $98.36 – $98.36 | 1 |
| Pegfilgrastim-cbqv 6 mg/0.6 ml subcutaneous syringe HCPCS Q5111 | $5,519.24 | $6,899.04 | $146.06 – $6,209.14 | 17 |
| Pegfilgrastim-fpgk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5127 | $6,616.16 | $8,270.20 | $311.44 – $7,443.18 | 17 |
| Pegfilgrastim-jmdb 6 mg/0.6 ml subcutaneous syringe HCPCS Q5108 | not published | not published | $138.08 – $138.08 | 1 |
| Pegfilgrastim-pbbk 6 mg/0.6 ml subcutaneous syringe HCPCS Q5130 | not published | not published | $189.71 – $189.71 | 1 |
| Pegloticase 8 mg/ml intravenous solution HCPCS J2507 | not published | not published | $3,547.84 – $3,547.84 | 1 |
| Pegunigalsidase alfa-iwxj HCPCS J2508 | not published | not published | $227.78 – $227.78 | 1 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $2,741.60 | $3,427.00 | $893.20 – $3,084.30 | 17 |
| Pelvic CT scan (with contrast) CPT 72193 | $2,378.40 | $2,973.00 | $893.20 – $2,675.70 | 17 |
| Pelvic CT scan (without contrast) CPT 72192 | $1,944.00 | $2,430.00 | $705.10 – $2,187.00 | 17 |
| Pelvic MRI (with and without contrast) CPT 72197 | $4,042.40 | $5,053.00 | $1,215.50 – $4,547.70 | 17 |
| Pelvic MRI (with contrast) CPT 72196 | $4,011.20 | $5,014.00 | $1,215.50 – $4,512.60 | 17 |
| Pelvic MRI (without contrast) CPT 72195 | $3,064.00 | $3,830.00 | $1,156.10 – $3,447.00 | 17 |
| Pelvic Ultrasound (complete) CPT 76856 | $921.60 | $1,152.00 | $590.98 – $1,036.80 | 17 |
| Pelvic Ultrasound (limited) CPT 76857 | $712.00 | $890.00 | $456.57 – $801.00 | 17 |
| Pelvis X-ray (1 to 2 views) CPT 72170 | $337.60 | $422.00 | $216.49 – $379.80 | 17 |
| Pelvis X-ray (complete, 4 or more views) CPT 72190 | $440.80 | $551.00 | $282.66 – $495.90 | 17 |
| Pembrolizumab 25 mg/ml intravenous solution HCPCS J9271 | not published | not published | $69.76 – $117.04 | 2 |
| Pemivibart infusion HCPCS M0224 | $760.00 | $950.00 | $487.35 – $855.00 | 17 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $471.48 | $589.34 | $302.33 – $530.41 | 17 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $217.86 | $272.32 | $41.55 – $72.89 | 17 |
| Pertuzumab 30 mg/ml desensitization HCPCS J9306 | not published | not published | $32.40 – $32.40 | 1 |
| Ph body fluid CPT 83986 | $46.40 | $58.00 | $29.75 – $52.20 | 17 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $71.58 | $89.47 | $45.90 – $80.52 | 17 |
| Phenobarbital therapeutic drug level CPT 80184 | $92.00 | $115.00 | $59.00 – $103.50 | 17 |
| Phentolaine mesylate inj HCPCS J2760 | $722.55 | $903.18 | $463.33 – $812.86 | 17 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $95.17 | $118.96 | $43.52 – $76.35 | 17 |
| Phenytoin total therapeutic drug level CPT 80185 | $121.60 | $152.00 | $64.13 – $112.50 | 17 |
| Phlebotomy therapeutic CPT 99195 | $258.40 | $323.00 | $165.70 – $290.70 | 17 |
| Phosphorus CPT 84100 | $54.40 | $68.00 | $34.88 – $61.20 | 17 |
| Phosphorus 24 hour urine CPT 84105 | $36.00 | $45.00 | $23.09 – $40.50 | 17 |
| Physical Therapy Evaluation (high complexity) CPT 97163 | $323.20 | $404.00 | $207.25 – $363.60 | 17 |
| Physical Therapy Evaluation (low complexity) CPT 97161 | $256.80 | $321.00 | $164.67 – $288.90 | 17 |
| Physical Therapy Evaluation (moderate complexity) CPT 97162 | $280.00 | $350.00 | $179.55 – $315.00 | 17 |
| Physical Therapy Re-Evaluation CPT 97164 | $145.60 | $182.00 | $93.37 – $163.80 | 17 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $86.50 | $108.12 | $40.40 – $70.88 | 17 |
| Pinworm exam CPT 87172 | $33.60 | $42.00 | $21.55 – $37.80 | 17 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $68.24 | $85.29 | $39.59 – $69.46 | 17 |
| Platelet aggregation each agent teg CPT 85576 | $178.40 | $223.00 | $114.40 – $200.70 | 17 |
| Platelet automated CPT 85049 | $32.80 | $41.00 | $21.03 – $36.90 | 17 |
| Platelets each unit HCPCS P9019 | $577.60 | $722.00 | $370.39 – $649.80 | 17 |
| Poct blood gases ph pco2 po2 arterial calculated o2 CPT 82803 | $209.60 | $262.00 | $134.41 – $235.80 | 17 |
| Polysomnography sleep staging >=4 parameters age >=6 years w/cpap bipap CPT 95811 | $4,729.60 | $5,912.00 | $3,032.86 – $5,320.80 | 17 |
| Potassium 24 hour urine CPT 84133 | $56.80 | $71.00 | $36.42 – $63.90 | 17 |
| Potassium chloride 10 meq/100ml in sterile water intravenous piggyback HCPCS J3480 | $109.46 | $136.82 | $39.65 – $69.57 | 17 |
| Potassium serum/plasma/whole blood CPT 84132 | $40.00 | $50.00 | $25.65 – $45.00 | 17 |
| Pralidoxime 1 gram solution for injection HCPCS J2730 | $188.68 | $235.84 | $120.99 – $212.26 | 17 |
| Pr application of long arm splint CPT 29105 | $381.60 | $477.00 | $244.70 – $429.30 | 17 |
| Pr application splint static short arm CPT 29125 | $352.80 | $441.00 | $226.23 – $396.90 | 17 |
| Prealbumin CPT 84134 | $108.00 | $135.00 | $69.26 – $121.50 | 17 |
| Prednisolone sodium phosphate 15 mg/5 ml (3 mg/ml) oral solution HCPCS J7510 | $3.40 | $4.25 | $2.18 – $3.83 | 17 |
| Pregnancy Ultrasound (complete, after first trimester) CPT 76805 | $957.60 | $1,197.00 | $614.06 – $1,077.30 | 17 |
| Pregnancy Ultrasound (limited) CPT 76815 | $567.20 | $709.00 | $363.72 – $638.10 | 17 |
| Pr excision nail/nail matrix partial/complete permanent removal CPT 11750 | $466.40 | $583.00 | $299.08 – $524.70 | 17 |
| Pr incision & drainage abscess simple/single CPT 10060 | $585.60 | $732.00 | $375.52 – $658.80 | 17 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $810.40 | $1,013.00 | $519.67 – $911.70 | 17 |
| Procalcitonin CPT 84145 | $244.00 | $305.00 | $156.47 – $274.50 | 17 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | $69.76 | $87.20 | $39.43 – $69.17 | 17 |
| Progesterone CPT 84144 | $125.60 | $157.00 | $80.54 – $141.30 | 17 |
| Prolactin CPT 84146 | $142.40 | $178.00 | $91.31 – $160.20 | 17 |
| Propofol infusion 10 mg/ml HCPCS J2704 | $64.24 | $80.30 | $41.19 – $72.27 | 17 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | $62.98 | $78.72 | $39.44 – $69.20 | 17 |
| Protein c activity CPT 85303 | $266.40 | $333.00 | $170.83 – $299.70 | 17 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $89.60 | $112.00 | $57.46 – $100.80 | 17 |
| Protein s total CPT 85305 | $45.60 | $57.00 | $24.11 – $42.30 | 17 |
| Protein total 24 hour urine CPT 84156 | $62.40 | $78.00 | $32.83 – $57.60 | 17 |
| Protein total body fluid CPT 84157 | $96.00 | $120.00 | $61.56 – $108.00 | 17 |
| Protein total serum plasma whole blood CPT 84155 | $50.40 | $63.00 | $32.32 – $56.70 | 17 |
| Prothrombin complex kcentra HCPCS J7168 | $1,572.80 | $1,966.00 | $1,008.56 – $1,769.40 | 17 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $292.00 | $365.00 | $187.25 – $328.50 | 17 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $944.00 | $1,180.00 | $605.34 – $1,062.00 | 17 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $473.60 | $592.00 | $303.70 – $532.80 | 17 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $504.00 | $630.00 | $323.19 – $567.00 | 17 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $458.40 | $573.00 | $293.95 – $515.70 | 17 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $506.40 | $633.00 | $324.73 – $569.70 | 17 |
| PSA (Prostate) Test CPT 84153 | $89.60 | $112.00 | $57.46 – $100.80 | 17 |
| Pt application of modality >=1 area iontophoresis each 15 minutes CPT 97033 | $139.20 | $174.00 | $89.26 – $156.60 | 17 |
| Pt application of modality >=1 area ultrasound each 15 minutes CPT 97035 | $102.40 | $128.00 | $65.66 – $115.20 | 17 |
| Pt application of modality traction mechanical CPT 97012 | $100.00 | $125.00 | $64.13 – $112.50 | 17 |
| Pt repositioning canalith procedure(s) per day CPT 95992 | $141.60 | $177.00 | $90.80 – $159.30 | 17 |
| Pt therapeutic procedure >=1 area massage each 15 minutes CPT 97124 | $97.60 | $122.00 | $62.59 – $109.80 | 17 |
| Pt wheelchair management each 15 minutes CPT 97542 | $112.80 | $141.00 | $72.33 – $126.90 | 17 |
| Pulse ox continuous overnight monitoring CPT 94762 | $412.00 | $515.00 | $264.20 – $463.50 | 17 |
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.