SANFORD CHAMBERLAIN MEDICAL CENTER
Critical Access Hospitals
16
Procedure Prices at SANFORD CHAMBERLAIN MEDICAL CENTER
Blood Draw From Vein Using Needle
CPT 36415
$3
Outpatient Clinic Visit Established Patient Level III
CPT 99213
$18.37
Therapeutic Exercises
CPT 97110
$52.8
EKG Tracing
CPT 93005
$59.6
Abdominal Ultrasound — Limited
CPT 76705
$61.08
Chest X-Ray (1 view)
CPT 71045
$64.6
Lab Test - Complete Blood Cell Count With White Blood Cell Percentage
CPT 85025
$70.36
Mechanical Traction
CPT 97012
$77.4
Chest X-Ray (2 views)
CPT 71046
$83
Screening Mammogram (bilateral)
CPT 77067
$95.29
Therapeutic Activities
CPT 97530
$96.24
Lab Test - Comprehensive Metabolic Panel
CPT 80053
$106.25
Diagnostic Mammogram (bilateral)
CPT 77066
$115.36
ER Visit — Moderate Complexity
CPT 99284
$208.83
ER Visit — Low-Moderate Complexity
CPT 99283
$242.27
Diagnostic Mammogram (unilateral)
CPT 77065
$426.59
ER Visit — High Complexity
CPT 99285
$433.97
Thoracic Spine X-Ray
CPT 72072
$510.66
CT Chest
CPT 71250
$533.4
Retroperitoneal Ultrasound
CPT 76770
$777.55
OB Ultrasound
CPT 76805
$912.78
Abdominal Ultrasound
CPT 76700
$956.34
Colonoscopy
CPT 45378
$1,630.2
CT Abdomen & Pelvis
CPT 74177
$2,115.08
MRI Brain w/o Contrast
CPT 70551
$2,406.73
Echocardiogram w/ Doppler
CPT 93306
$2,470.81
MRI Joint of Lower Extremity
CPT 73721
$2,524.75
Colonoscopy w/ Biopsy
CPT 45380
$3,174.33
Upper GI Endoscopy w/ Biopsy
CPT 43239
$3,418.49
MRI Brain w/ Contrast
CPT 70553
$3,504.17
Cataract Surgery
CPT 66984
$4,370
Knee Arthroscopy
CPT 29881
$9,366.62
Laparoscopic Cholecystectomy
CPT 47562
$11,719.42
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Prices sourced from federally mandated hospital price transparency files. Cash prices reflect self-pay discounted rates. Negotiated rates vary by insurance plan. Data may not reflect current pricing — always confirm with the hospital before scheduling.