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 |
|---|---|---|---|---|
| Sterile water/saline, 10 ml HCPCS A4216 | $4.16 | $5.20 | $2.62 – $4.59 | 17 |
| St evaluate speech sound production CPT 92522 | $346.40 | $433.00 | $222.13 – $389.70 | 17 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $501.60 | $627.00 | $321.65 – $564.30 | 17 |
| Stomach Emptying Scan (Nuclear Medicine) CPT 78264 | $1,841.60 | $2,302.00 | $1,180.93 – $2,071.80 | 17 |
| Stress test pulmonary CPT 94618 | $413.60 | $517.00 | $265.22 – $465.30 | 17 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $71.61 | $89.51 | $40.55 – $71.15 | 17 |
| Support clav 29.6-40.5in med HCPCS L3650 | $24.80 | $31.00 | $15.90 – $27.90 | 17 |
| Surgical pathology level 1 gross examination only CPT 88300 | $36.00 | $45.00 | $23.09 – $40.50 | 17 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $77.60 | $97.00 | $49.76 – $87.30 | 17 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $108.80 | $136.00 | $69.77 – $122.40 | 17 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $118.40 | $148.00 | $75.92 – $159.50 | 17 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $576.80 | $721.00 | $369.87 – $648.90 | 17 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $894.40 | $1,118.00 | $573.53 – $1,006.20 | 17 |
| Susceptibility agar dilution per agent CPT 87181 | $76.00 | $95.00 | $21.55 – $37.80 | 17 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $48.80 | $61.00 | $31.29 – $54.90 | 17 |
| Susceptibility mic per plate CPT 87186 | $76.00 | $95.00 | $48.74 – $85.50 | 17 |
| Swallowing Evaluation (Bedside) CPT 92610 | $378.40 | $473.00 | $242.65 – $425.70 | 17 |
| Swallowing Therapy Session CPT 92526 | $300.00 | $375.00 | $192.38 – $337.50 | 17 |
| T3 (triiodothyronine) free CPT 84481 | $132.00 | $165.00 | $84.65 – $148.50 | 17 |
| T3 (triiodothyronine) total CPT 84480 | $124.00 | $155.00 | $79.52 – $139.50 | 17 |
| T4 (thyroxine) free CPT 84439 | $66.40 | $83.00 | $42.58 – $74.70 | 17 |
| T4 (thyroxine) total CPT 84436 | $70.40 | $88.00 | $45.14 – $79.20 | 17 |
| Tacrolimus therapeutic drug level CPT 80197 | $219.20 | $274.00 | $140.56 – $246.60 | 17 |
| Tailbone (Sacrum and Coccyx) X-ray CPT 72220 | $351.20 | $439.00 | $225.21 – $395.10 | 17 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $214.40 | $268.00 | $137.48 – $241.20 | 17 |
| Tc-99m maa HCPCS A9540 | $936.80 | $1,171.00 | $600.72 – $1,053.90 | 17 |
| Tc-99m mebrofenin HCPCS A9537 | $178.40 | $223.00 | $114.40 – $200.70 | 17 |
| Tc-99m medronate HCPCS A9503 | $133.60 | $167.00 | $85.67 – $150.30 | 17 |
| Tc-99m mertiatide HCPCS A9562 | $756.00 | $945.00 | $484.79 – $850.50 | 17 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $352.00 | $440.00 | $225.72 – $396.00 | 17 |
| Tc-99m sulfur colloid HCPCS A9541 | $308.00 | $385.00 | $197.51 – $346.50 | 17 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $120.00 | $150.00 | $76.95 – $135.00 | 17 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $188.00 | $235.00 | $120.56 – $211.50 | 17 |
| T cells absolute cd 4 count CPT 86361 | $168.80 | $211.00 | $108.24 – $189.90 | 17 |
| T cells total count CPT 86359 | $188.80 | $236.00 | $121.07 – $212.40 | 17 |
| Telehealth original site facility fee HCPCS Q3014 | $56.00 | $70.00 | $35.91 – $63.00 | 17 |
| Tenecteplase 5 mg/ml intravenous solution for ischemic stroke (50 mg vial) HCPCS J3101 | $12,366.50 | $15,458.12 | $5,546.07 – $9,729.95 | 17 |
| Terbutaline 1 mg/ml subcutaneous solution HCPCS J3105 | $63.00 | $78.74 | $39.23 – $68.83 | 17 |
| Test stress cardiovascular tracing only CPT 93017 | $1,179.20 | $1,474.00 | $756.16 – $1,326.60 | 17 |
| Tetanus immune globulin inj HCPCS J1670 | $598.64 | $748.30 | $383.88 – $673.47 | 17 |
| Tezepelumab-ekko 210 mg/1.91 ml (110 mg/ml) subcutaneous syringe HCPCS J2356 | not published | not published | $18.45 – $18.45 | 1 |
| Theophylline therapeutic drug level CPT 80198 | $112.80 | $141.00 | $72.33 – $126.90 | 17 |
| Therapy Activity Training (each 15 minutes) CPT 97530 | $125.60 | $157.00 | $80.54 – $141.30 | 17 |
| Therapy Exercise Session (each 15 minutes) CPT 97110 | $126.40 | $158.00 | $81.05 – $142.20 | 17 |
| Therapy nutrition individual initial f2f w/patient each 15 minutes CPT 97802 | $64.00 | $80.00 | $41.04 – $72.00 | 17 |
| Ther/proph/diag inj ia CPT 96373 | not published | not published | $44.80 – $44.80 | 1 |
| Thiamine hcl (vitamin b1) 100 mg/ml injection solution HCPCS J3411 | $63.50 | $79.37 | $39.74 – $69.72 | 17 |
| Thigh Bone (Femur) X-ray (both sides) CPT 73552 | $321.60 | $402.00 | $206.23 – $361.80 | 17 |
| Thoracentesis pleural space needle/catheter aspiration with imaging guidance (both sides) CPT 32555 | $1,804.00 | $2,255.00 | $1,156.82 – $2,029.50 | 17 |
| Three-Phase Bone Scan (Nuclear Medicine) CPT 78315 | $2,268.00 | $2,835.00 | $1,454.36 – $2,551.50 | 17 |
| Thromboplastin time partial (ptt) substitution fractions each CPT 85732 | $69.60 | $87.00 | $44.63 – $78.30 | 17 |
| Thyroglobulin antibody CPT 86800 | $125.60 | $157.00 | $33.86 – $59.40 | 17 |
| Thyroid (TSH) Test CPT 84443 | $81.60 | $102.00 | $52.33 – $99.00 | 17 |
| Thyroid Ultrasound CPT 76536 | $807.20 | $1,009.00 | $517.62 – $908.10 | 17 |
| Thyroxine binding globulin (tbg) CPT 84442 | $48.80 | $61.00 | $31.29 – $54.90 | 17 |
| Tigecycline injection HCPCS J3243 | $271.86 | $339.82 | $174.33 – $305.84 | 17 |
| Tirofiban 12.5 mg/50 ml HCPCS J3246 | $473.23 | $591.53 | $303.45 – $532.38 | 17 |
| Tissue exam koh skin/hair/nails CPT 87220 | $47.20 | $59.00 | $30.27 – $53.10 | 17 |
| Tissue transglutaminase iga CPT 86364 | $79.20 | $99.00 | $50.79 – $89.10 | 17 |
| Tl-201 thallium diag per mci HCPCS A9505 | $78.40 | $98.00 | $50.27 – $88.20 | 17 |
| Tobramycin in ns IV syringe 4 mg/ml (neo/ped) - cnr HCPCS J3260 | $61.82 | $77.27 | $39.64 – $69.54 | 17 |
| Tobramycin peak therapeutic drug level CPT 80200 | $177.60 | $222.00 | $113.89 – $199.80 | 17 |
| Tocilizumab 162 mg/0.9 ml subcutaneous pen injector HCPCS J3262 | not published | not published | $6.08 – $6.08 | 1 |
| Toe X-ray (both feet) CPT 73660 | $240.80 | $301.00 | $154.41 – $270.90 | 17 |
| Tomosynthesis breast screen bilateral CPT 77063 | $90.40 | $113.00 | $57.97 – $165.00 | 17 |
| Toripalimab-tpzi 240 mg/6 ml (40 mg/ml) intravenous solution HCPCS J3263 | not published | not published | $46.57 – $46.57 | 1 |
| Toxoplasma antibody igg CPT 86777 | $112.80 | $141.00 | $72.33 – $126.90 | 17 |
| Toxoplasma antibody igm CPT 86778 | $141.60 | $177.00 | $90.80 – $159.30 | 17 |
| Training self management diabetes individual outpatient department per 30 minutes HCPCS G0108 | $123.20 | $154.00 | $79.00 – $138.60 | 17 |
| Transferrin CPT 84466 | $108.00 | $135.00 | $69.26 – $121.50 | 17 |
| Transvaginal Pelvic Ultrasound (not pregnancy) CPT 76830 | $834.40 | $1,043.00 | $535.06 – $938.70 | 17 |
| Transvaginal Pregnancy Ultrasound CPT 76817 | $812.80 | $1,016.00 | $521.21 – $914.40 | 17 |
| Trastuzumab 150 mg intravenous solution HCPCS J9355 | not published | not published | $93.40 – $168.98 | 2 |
| Trastuzumab-anns 150 mg intravenous solution HCPCS Q5117 | not published | not published | $29.15 – $29.15 | 1 |
| Trastuzumab-qyyp 150 mg intravenous solution HCPCS Q5116 | not published | not published | $22.97 – $22.97 | 1 |
| Trauma partial team response w/critical care services level 4 HCPCS G0390 | $2,387.20 | $2,984.00 | $1,530.79 – $2,685.60 | 17 |
| Treponema pallidum antibody CPT 86780 | $70.40 | $88.00 | $45.14 – $79.20 | 17 |
| Triamcinolone acetonide 40 mg/ml suspension for injection HCPCS J3301 | $67.01 | $83.76 | $40.00 – $70.17 | 17 |
| Triglycerides CPT 84478 | $65.60 | $82.00 | $42.07 – $73.80 | 17 |
| Troponin quantitative CPT 84484 | $140.00 | $175.00 | $89.78 – $157.50 | 17 |
| Ublituximab-xiiy 25 mg/ml intravenous solution HCPCS J2329 | not published | not published | $70.76 – $70.76 | 1 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $531.20 | $664.00 | $340.63 – $597.60 | 17 |
| Unlisted ultrasound procedure CPT 76999 | $628.80 | $786.00 | $403.22 – $707.40 | 17 |
| Upper Arm (Humerus) X-ray (left side) CPT 73060 | $337.60 | $422.00 | $216.49 – $379.80 | 17 |
| Upper Back (Thoracic Spine) CT Scan (with contrast) CPT 72129 | not published | not published | $893.20 – $893.20 | 1 |
| Upper Back (Thoracic Spine) CT Scan (without contrast) CPT 72128 | $2,539.20 | $3,174.00 | $705.10 – $2,856.60 | 17 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $4,424.00 | $5,530.00 | $1,215.50 – $4,977.00 | 17 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $3,414.40 | $4,268.00 | $1,215.50 – $3,841.20 | 17 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $3,372.00 | $4,215.00 | $1,156.10 – $3,793.50 | 17 |
| Upper Back (Thoracic Spine) X-ray (2 views) CPT 72070 | $404.00 | $505.00 | $259.07 – $454.50 | 17 |
| Upper Back (Thoracic Spine) X-ray (3 views) CPT 72072 | $483.20 | $604.00 | $309.85 – $543.60 | 17 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | not published | not published | $2,270.40 – $2,270.40 | 1 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $2,577.60 | $3,222.00 | $1,652.89 – $2,899.80 | 17 |
| Urea nitrogen CPT 84520 | $40.00 | $50.00 | $25.65 – $45.00 | 17 |
| Urea nitrogen 24 hour urine CPT 84540 | $39.20 | $49.00 | $25.14 – $44.10 | 17 |
| Uric acid blood CPT 84550 | $40.00 | $50.00 | $25.65 – $45.00 | 17 |
| Uric acid urine CPT 84560 | $36.00 | $45.00 | $23.09 – $40.50 | 17 |
| Urinalysis microscopic only CPT 81015 | $22.40 | $28.00 | $14.36 – $25.20 | 17 |
| Urinalysis (with microscopy) CPT 81001 | $32.80 | $41.00 | $21.03 – $36.90 | 17 |
| Urinalysis (without microscopy) CPT 81003 | $24.80 | $31.00 | $15.90 – $27.90 | 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.