SANFORD MEDICAL CENTER MAYVILLE
Critical Access Hospitals
16
Procedure Prices at SANFORD MEDICAL CENTER MAYVILLE
Blood Draw From Vein Using Needle
CPT 36415
$3
Lab Test - Complete Blood Cell Count With White Blood Cell Percentage
CPT 85025
$6.75
Lab Test - Comprehensive Metabolic Panel
CPT 80053
$9.18
EKG Tracing
CPT 93005
$24.46
Therapeutic Exercises
CPT 97110
$29.96
Chest X-Ray (2 views)
CPT 71046
$34.01
Mechanical Traction
CPT 97012
$46.8
Outpatient Clinic Visit Established Patient Level III
CPT 99213
$52.35
Chest X-Ray (1 view)
CPT 71045
$62.72
Thoracic Spine X-Ray
CPT 72072
$99.48
Retroperitoneal Ultrasound
CPT 76770
$107.2
Therapeutic Activities
CPT 97530
$118.8
Individual Psychotherapy Session for 60 Minutes
CPT 90837
$124.32
Screening Mammogram (bilateral)
CPT 77067
$133.35
ER Visit — High Complexity
CPT 99285
$276.88
Abdominal Ultrasound — Limited
CPT 76705
$318.15
OB Ultrasound
CPT 76805
$344.27
Diagnostic Mammogram (unilateral)
CPT 77065
$387
ER Visit — Moderate Complexity
CPT 99284
$408.7
Diagnostic Mammogram (bilateral)
CPT 77066
$427.56
Abdominal Ultrasound
CPT 76700
$442.53
ER Visit — Low-Moderate Complexity
CPT 99283
$539.4
CT Chest
CPT 71250
$714.25
Echocardiogram w/ Doppler
CPT 93306
$838.78
MRI Brain w/o Contrast
CPT 70551
$1,076.2
MRI Joint of Lower Extremity
CPT 73721
$1,172.52
MRI Brain w/ Contrast
CPT 70553
$1,275.52
CT Abdomen & Pelvis
CPT 74177
$1,417.62
Colonoscopy w/ Biopsy
CPT 45380
$1,427.72
Colonoscopy
CPT 45378
$1,602.8
Upper GI Endoscopy w/ Biopsy
CPT 43239
$1,740.41
Cataract Surgery
CPT 66984
$2,534.58
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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.