SANFORD SHELDON MEDICAL CENTER
Critical Access Hospitals
16
Procedure Prices at SANFORD SHELDON MEDICAL CENTER
Blood Draw From Vein Using Needle
CPT 36415
$5.09
Lab Test - Complete Blood Cell Count With White Blood Cell Percentage
CPT 85025
$22
Lab Test - Comprehensive Metabolic Panel
CPT 80053
$29.79
Outpatient Clinic Visit Established Patient Level III
CPT 99213
$40.13
Chest X-Ray (1 view)
CPT 71045
$44.05
Therapeutic Activities
CPT 97530
$46.58
Therapeutic Exercises
CPT 97110
$48.14
Chest X-Ray (2 views)
CPT 71046
$64.3
Thoracic Spine X-Ray
CPT 72072
$65.17
Screening Mammogram (bilateral)
CPT 77067
$67.55
EKG Tracing
CPT 93005
$88.81
Mechanical Traction
CPT 97012
$96.62
Diagnostic Mammogram (unilateral)
CPT 77065
$142.08
Diagnostic Mammogram (bilateral)
CPT 77066
$180.97
OB Ultrasound
CPT 76805
$193.3
Abdominal Ultrasound — Limited
CPT 76705
$210.74
Retroperitoneal Ultrasound
CPT 76770
$276.41
ER Visit — Low-Moderate Complexity
CPT 99283
$285.65
Abdominal Ultrasound
CPT 76700
$351.8
Upper GI Endoscopy w/ Biopsy
CPT 43239
$384.93
CT Chest
CPT 71250
$405.75
ER Visit — Moderate Complexity
CPT 99284
$479.94
Echocardiogram w/ Doppler
CPT 93306
$488.29
MRI Brain w/o Contrast
CPT 70551
$552.5
Colonoscopy
CPT 45378
$686.16
Colonoscopy w/ Biopsy
CPT 45380
$856.88
MRI Joint of Lower Extremity
CPT 73721
$880.07
ER Visit — High Complexity
CPT 99285
$934.72
CT Abdomen & Pelvis
CPT 74177
$951.99
MRI Brain w/ Contrast
CPT 70553
$1,214.86
Laparoscopic Cholecystectomy
CPT 47562
$2,090.16
Inguinal Hernia Repair
CPT 49505
$2,723.8
Knee Arthroscopy
CPT 29881
$5,232.64
Recurrent Inguinal Hernia Repair
CPT 49520
$6,648.14
Appendectomy
CPT 44950
$21,192.14
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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.