SANFORD CLEAR LAKE MEDICAL CENTER
Critical Access Hospitals
16
Procedure Prices at SANFORD CLEAR LAKE MEDICAL CENTER
Blood Draw From Vein Using Needle
CPT 36415
$3
Lab Test - Complete Blood Cell Count With White Blood Cell Percentage
CPT 85025
$6.72
Lab Test - Comprehensive Metabolic Panel
CPT 80053
$9.13
Therapeutic Exercises
CPT 97110
$86.5
Mechanical Traction
CPT 97012
$91.38
Therapeutic Activities
CPT 97530
$95.06
Screening Mammogram (bilateral)
CPT 77067
$95.29
EKG Tracing
CPT 93005
$147.08
Chest X-Ray (1 view)
CPT 71045
$206.23
Outpatient Clinic Visit Established Patient Level III
CPT 99213
$240.3
Chest X-Ray (2 views)
CPT 71046
$251.44
Thoracic Spine X-Ray
CPT 72072
$444.6
Abdominal Ultrasound — Limited
CPT 76705
$542.71
ER Visit — Moderate Complexity
CPT 99284
$663.69
ER Visit — Low-Moderate Complexity
CPT 99283
$715.55
ER Visit — High Complexity
CPT 99285
$846.08
Retroperitoneal Ultrasound
CPT 76770
$863.88
Abdominal Ultrasound
CPT 76700
$1,020.75
Upper GI Endoscopy w/ Biopsy
CPT 43239
$1,826.78
Colonoscopy w/ Biopsy
CPT 45380
$1,989.63
Echocardiogram w/ Doppler
CPT 93306
$1,993.08
CT Chest
CPT 71250
$2,034
MRI Joint of Lower Extremity
CPT 73721
$2,178.24
Colonoscopy
CPT 45378
$2,721.19
MRI Brain w/o Contrast
CPT 70551
$2,881.61
MRI Brain w/ Contrast
CPT 70553
$3,311.34
CT Abdomen & Pelvis
CPT 74177
$3,910.14
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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.