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$585.99
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Sanford Luverne Medical Center Menu
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Infusion Therapy - Hydration Infusion Into A Vein, 31 Minutes To 1 Hour (1004691) | $156.00 |
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Heart Monitoring - Routine Ekg Using At Least 12 Leads, Tracing Only (1003192) | $133.00 |
N/A
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Heart Monitoring - Continuous Heart Rhythm Recording Up To 48 Hours, Recording Only (1004302) | $445.00 |
N/A
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Heart Monitoring - Continuous Heart Rhythm Recording Up To 48 Hours, Analysis With Report (1004303) | $634.00 |
N/A
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Gi Services - Dilation Of Upper Gastrointestinal Tract Using Endoscope (1009848) | $1,390.00 |
N/A
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Gi Services - Diagnostic Exam Of Upper Gastrointestinal Tract Using Endoscope (1002418) | $1,193.00 |
N/A
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Gi Services - Diagnostic Exam Of Small Intestine Using Flexible Endoscope (1002077) | $1,260.00 |
N/A
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Gi Services - Diagnostic Exam Of Large Intestine (1000908) | $1,260.00 |
N/A
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Gi Services - Biopsy Of Upper Gastrointestinal Tract Using Endoscope (1002421) | $1,504.00 |
N/A
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Gi Services - Biopsy Of Small Intestine Using Flexible Endoscope (1002076) | $1,260.00 |
N/A
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Gi Services - Biopsy Of Large Intestine Growth (1000905) | $1,569.00 |
N/A
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Emergency Room - Treatment Of Dislocated Hand (1007184) | $47.00 |
N/A
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Emergency Room - Treatment Of 1St Degree Burn (1007135) | $143.00 |
N/A
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Emergency Room - Simple Wound Repair Of Scalp, Neck, Underarm, Trunk, Arm Or Leg, Less Than 7.6-12.5 Cm (1007095) | $212.00 |
N/A
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Emergency Room - Simple Wound Repair Of Scalp, Neck, Underarm, Trunk, Arm Or Leg, Less Than 2.5 Cm (1007093) | $130.00 |
N/A
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Emergency Room - Simple Wound Repair Of Scalp, Neck, Underarm, Trunk, Arm Or Leg, 2.6-7.5 Cm (1007094) | $172.00 |
N/A
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Emergency Room - Simple Wound Repair Of Face, Less Than 2.5 Cm (1007099) | $201.00 |
N/A
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Emergency Room - Simple Wound Repair Of Face, 2.6-5 Cm (1007100) | $228.00 |
N/A
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Emergency Room - Simple Insertion Of Bladder Catheter (1007715) | $30.00 |
N/A
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Emergency Room - Simple Control Of Nosebleed (1007230) | $118.00 |
N/A
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Emergency Room - Simple Change Of Bladder Tube Through Abdominal Wall (1007375) | $47.00 |
N/A
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Emergency Room - Removal Of Imacted Earwax From One Ear (1026686) | $27.00 |
N/A
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Emergency Room - Removal Of Foreign Body From Eye Surface (1007274) | $53.00 |
N/A
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Emergency Room - Removal Of Foreign Body From Eye Surface (1004837) | $35.00 |
N/A
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Emergency Room - Removal Of Foreign Body From Ear Canal (1006759) | $106.00 |
N/A
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Emergency Room - Manipulation Of Dislocated Shoulder Without Incision (1007152) | $42.00 |
N/A
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Emergency Room - Manipulation Of Dislocated Elbow Without Incision (1007158) | $271.00 |
N/A
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Emergency Room - Manipulation Of Broken Lower Wrist Without Incision (1007168) | $165.00 |
N/A
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Emergency Room - Manipulation Of Broken Finger Without Incision (1007182) | $47.00 |
N/A
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Emergency Room - Intermediate Wound Repair Of Neck, Hands, Feet Or Genitals, 2.6-7.5 Cm (1007113) | $322.00 |
N/A
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Emergency Room - Intermediate Wound Repair Of Neck, Hands, Feet Or Genitals, 2.6-7.5 Cm (1007107) | $256.00 |
N/A
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Emergency Room - Intermediate Repair Of Face, Less Than 2.5 Cm (1007118) | $44.00 |
N/A
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Emergency Room - Insertion Of Temporary Bladder Catheter (1007713) | $30.00 |
N/A
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Emergency Room - Injection Therapy For Diagnosis Or Prevention, Under The Skin Or Into Muscle (1007690) | $255.00 |
N/A
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Emergency Room - Injection Therapy For Diagnosis Or Prevention, Into Vein (1007691) | $308.00 |
N/A
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Emergency Room - Injection Therapy For Diagnosis Or Prevention, Additional Sequential Injection Of Same Substance Into Vein (1008109) | $161.00 |
N/A
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Emergency Room - Injection Therapy For Diagnosis Or Prevention, Additional Sequential Injection Of New Substance Into Vein (1004698) | $171.00 |
N/A
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Emergency Room - Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, Up To 1 Hour (1007687) | $360.00 |
N/A
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Emergency Room - Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, Concurrent With Another Infusion (1007775) | $240.00 |
N/A
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Emergency Room - Infusion Into A Vein For Therapy, Prevention, Or Diagnosis, Additional Hour (1007685) | $270.00 |
N/A
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Emergency Room - Infusion Into A Vein For Therapy Prevention Or Diagnosis, Additional Sequential Infusion Up To 1 Hour (1007774) | $285.00 |
N/A
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Emergency Room - Incision And Drainage Of Simple Abscess (1007081) | $144.00 |
N/A
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Emergency Room - Incision And Drainage Of Fluid Collection (1007088) | $300.00 |
N/A
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Emergency Room - Hydration Infusion Into A Vein, Additional Hour (1007688) | $154.00 |
N/A
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Emergency Room - Hydration Infusion Into A Vein, 31 Minutes To 1 Hour (1007689) | $291.00 |
N/A
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Emergency Room - Exploration Of Open Wound (1007385) | $193.00 |
N/A
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Emergency Room - Emergency Insertion Of Breathing Tube (1007234) | $341.00 |
N/A
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Emergency Room - Emergency Department Visit, Self Limited Or Minor Problem (1003894) | $154.00 |
N/A
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Emergency Room - Emergency Department Visit, Problem With Significant Threat To Life Or Function (1003898) | $1,300.00 |
N/A
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Emergency Room - Emergency Department Visit, Problem Of High Severity (1003887) | $876.00 |
N/A
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Emergency Room - Emergency Department Visit, Problem Of High Severity (1003888) | $876.00 |
N/A
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Emergency Room - Emergency Department Visit, Moderately Severe Problem (1003909) | $459.00 |
N/A
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Emergency Room - Emergency Department Visit, Low To Moderately Severe Problem (1003905) | $301.00 |
N/A
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Emergency Room - Dressing Change Or Removal Of Burn Tissue From Small Area (1004775) | $90.00 |
N/A
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Emergency Room - Critical Care Delivery Critically Ill Or Injured Patient, First 30-74 Minutes (1003841) | $1,539.00 |
N/A
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Emergency Room - Control Of Arterial Nosebleed With Packing (1006816) | $37.00 |
N/A
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Emergency Room - Complex Control Of Septal Nosebleed (1004822) | $175.00 |
N/A
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Emergency Room - Change Of Feeding Tube Through Abdominal Wall (1007252) | $38.00 |
N/A
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Emergency Room - Attempt To Restart Heart And Lungs (1003271) | $5,640.00 |
N/A
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Emergency Room - Aspiration Of Blood Collection Or Abscess Underneath The Skin (1004817) | $35.00 |
N/A
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Emergency Room - Application Of Short Leg Splint (1007222) | $90.00 |
N/A
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Emergency Room - Application Of Short Arm Splint (1004802) | $70.00 |
N/A
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Emergency Room - Application Of Short Arm Cast (1007205) | $99.00 |
N/A
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Emergency Room - Application Of Long Leg Splint (1007219) | $92.00 |
N/A
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Emergency Room - Application Of Long Arm Splint (1007208) | $104.00 |
N/A
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Emergency Room - Application Of Finger Splint (1007215) | $66.00 |
N/A
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Education - Smoking And Tobacco Use Intermediate Counseling, Greater Than 3 Minutes Up To 10 Minutes (1004627) | $29.00 |
N/A
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Education - Smoking And Tobacco Use Intensive Counseling, Greater Than 10 Minutes (1004476) | $55.00 |
N/A
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Education - Face-To-Face Behavioral Counseling For Obesity - Individual (1021426) | $48.00 |
N/A
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Education - Education And Training For Patient Self-Management, Each 30 Minutes (1013398) | $63.00 |
N/A
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Education - Diabetes Self-Management Training (1004370) | $124.00 |
N/A
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Drug Rehabilitation - Alcohol/drug - Other Treatment Program Per Hour (1010883) | $131.00 |
N/A
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Drug Rehabilitation - Alcohol/drug - Other Treatment Program Per Hour (1020949) | $64.00 |
N/A
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Diagnostic Tests - Nerve Transmission Studies, 9 To 10 Studies (1012944) | $580.00 |
N/A
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Diagnostic Tests - Nerve Transmission Studies, 7 To 8 Studies (1012943) | $516.00 |
N/A
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Diagnostic Tests - Nerve Transmission Studies, 5 To 6 Studies (1012942) | $395.00 |
N/A
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Diagnostic Tests - Nerve Transmission Studies, 3 To 4 Studies (1012941) | $333.00 |
N/A
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Diagnostic Tests - Nerve Transmission Studies, 13 Or More Studies (1012948) | $631.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Veins Of One Arm Or Leg Or Limited (1003424) | $737.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Veins Of Both Arms Or Legs (1003396) | $1,137.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Head And Neck Blood Vessels On One Side (1003410) | $684.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Head And Neck Blood Vessels On Both Sides (1003395) | $1,070.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Arteries And Arterial Grafts Of One Leg Or Limited (1003407) | $841.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Arteries And Arterial Grafts Of One Arm Or Limited (1003415) | $723.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Arteries And Arterial Grafts Of Both Legs (1003406) | $1,363.00 |
N/A
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Diagnostic Services - Ultrasound Scan Of Arteries And Arterial Grafts Of Both Arms (1003428) | $1,138.00 |
N/A
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Diagnostic Services - Sleep Monitoring Of Patient In Sleep Lab With Continuous Positive Airway Pressure (Cpap) Assistance By Mask Or Breathing Tube (1002092) | $4,063.00 |
N/A
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Diagnostic Services - Sleep Monitoring Of Patient In Sleep Lab With Continuous Positive Airway Pressure (Cpap) Assistance By Mask Or Breathing Tube (1007767) | $4,063.00 |
N/A
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Diagnostic Services - Sleep Monitoring Of Patient In Sleep Lab (1002091) | $3,541.00 |
N/A
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Diagnostic Services - Limited Ultrasound Scan Of Arteries Of Both Arms Or Legs (1007719) | $501.00 |
N/A
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Diagnostic Services - Limited Ultrasound Scan Of Arteries Of Both Arms Or Legs (1003398) | $501.00 |
N/A
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Diagnostic Services - Limited Ultrasound Scan Of Abdominal, Pelvic, Or Scrotal Blood Vessels (1003414) | $815.00 |
N/A
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Diagnostic Services - Home Sleep Study Test - Type Iii Portable Monitor (1021868) | $349.00 |
N/A
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Diagnostic Services - Complete Ultrasound Scan Of Aorta, Vena Cava, Groin Vessel Or Bypass Graft Blood Flow (1004811) | $995.00 |
N/A
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Diagnostic Services - Complete Ultrasound Scan Of Abdominal, Pelvic, Or Scrotal Blood Vessels (1003399) | $1,389.00 |
N/A
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Diagnostic Imaging - X-Rays For Complete Skeletal Bone Survey (1001632) | $383.00 |
N/A
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Diagnostic Imaging - X-Ray Of Wrist, 3 Or More Views (1002535) | $164.00 |
N/A
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Diagnostic Imaging - X-Ray Of Wrist, 2 Views (1002533) | $129.00 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Spine, 4 Or 5 Views (1000850) | $183.00 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Spine, 2 Or 3 Views (1000851) | $137.00 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Leg, 2 Or More Views (1025889) | $141.00 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Digestive Tract Without X-Ray Of Urinary System (1007744) | $496.00 |
N/A
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Diagnostic Imaging - X-Ray Of Upper Arm, 2 Or More Views (1001370) | $129.00 |
N/A
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Diagnostic Imaging - X-Ray Of Toe(S), 2 Or More Views (1002326) | $132.00 |
N/A
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Diagnostic Imaging - X-Ray Of Soft Tissue Of Neck (1001663) | $126.00 |
N/A
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Diagnostic Imaging - X-Ray Of Skull, 1 To 3 Views (1002090) | $147.00 |
N/A
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Diagnostic Imaging - X-Ray Of Shoulder, 2 Or More Views (1002062) | $122.00 |
N/A
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Diagnostic Imaging - X-Ray Of Sacrum And Tailbone, 2 Or More Views (1001975) | $124.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On One Side Of Body, 2 Views (1003534) | $136.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On One Side Of Body With X-Ray Of Chest, 3 Or More Views (1001947) | $142.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On Both Sides Of Body, 3 Views (1005301) | $151.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ribs On Both Sides Of Body With X-Ray Of Chest, 4 Or More Views (1001948) | $198.00 |
N/A
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Diagnostic Imaging - X-Ray Of Pelvis, 3 Or More Views (1003598) | $173.00 |
N/A
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Diagnostic Imaging - X-Ray Of Pelvis, 1 Or 2 Views (1001804) | $147.00 |
N/A
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Diagnostic Imaging - X-Ray Of One Hip With Pelvis, 4 Or More Views (1025884) | $236.00 |
N/A
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Diagnostic Imaging - X-Ray Of One Hip With Pelvis, 2 To 3 Views (1025883) | $189.00 |
N/A
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Diagnostic Imaging - X-Ray Of Nose Bones, 3 Or More Views (1001660) | $146.00 |
N/A
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Diagnostic Imaging - X-Ray Of Middle Spine, 3 Views (1001040) | $151.00 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral), 4 Or More Views (1001575) | $209.00 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Spine (Lumbar And Sacral), 2 Or 3 Views (1001574) | $151.00 |
N/A
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Diagnostic Imaging - X-Ray Of Lower Leg, 2 Views (1002315) | $127.00 |
N/A
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Diagnostic Imaging - X-Ray Of Knee, 4 Or More Views (1001482) | $176.00 |
N/A
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Diagnostic Imaging - X-Ray Of Knee, 3 Views (1004687) | $161.00 |
N/A
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Diagnostic Imaging - X-Ray Of Knee, 1 Or 2 Views (1001481) | $139.00 |
N/A
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Diagnostic Imaging - X-Ray Of Hand, 3 Or More Views (1001318) | $139.00 |
N/A
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Diagnostic Imaging - X-Ray Of Hand, 2 Views (1001326) | $112.00 |
N/A
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Diagnostic Imaging - X-Ray Of Forearm, 2 Views (1001229) | $109.00 |
N/A
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Diagnostic Imaging - X-Ray Of Foot, 3 Or More Views (1001227) | $129.00 |
N/A
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Diagnostic Imaging - X-Ray Of Foot, 2 Views (1001228) | $114.00 |
N/A
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Diagnostic Imaging - X-Ray Of Finger(S), 2 Or More Views (1001217) | $149.00 |
N/A
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Diagnostic Imaging - X-Ray Of Face Bones, 3 Or More Views (1001187) | $176.00 |
N/A
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Diagnostic Imaging - X-Ray Of Esophagus (1001163) | $403.00 |
N/A
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Diagnostic Imaging - X-Ray Of Elbow, 3 Or More Views (1001121) | $141.00 |
N/A
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Diagnostic Imaging - X-Ray Of Elbow, 2 Views (1001122) | $121.00 |
N/A
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Diagnostic Imaging - X-Ray Of Collarbone (1000882) | $121.00 |
N/A
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Diagnostic Imaging - X-Ray Of Chest, 2 Views (1027615) | $79.00 |
N/A
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Diagnostic Imaging - X-Ray Of Chest, 1 View (1027614) | $44.00 |
N/A
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Diagnostic Imaging - X-Ray Of Both Hips With Pelvis, 5 Or More Views (1025887) | $256.00 |
N/A
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Diagnostic Imaging - X-Ray Of Both Hips With Pelvis, 3 To 4 Views (1025886) | $214.00 |
N/A
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Diagnostic Imaging - X-Ray Of Bile Or Pancreatic Ducts With Contrast Injection During Surgery (1000872) | $751.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ankle, 3 Or More Views (1000552) | $141.00 |
N/A
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Diagnostic Imaging - X-Ray Of Ankle, 2 Views (1000553) | $136.00 |
N/A
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Diagnostic Imaging - X-Ray Of Abdomen, 2 Views (1027619) | $89.00 |
N/A
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Diagnostic Imaging - X-Ray Of Abdomen, 1 View (1027618) | $72.00 |
N/A
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Diagnostic Imaging - X-Ray For Joint Survey Of 2 Or More Joints Using Single View (1006895) | $131.00 |
N/A
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Diagnostic Imaging - Vaginal Ultrasound Of Fetus (1003180) | $468.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Or First Fetus At Less Than 14 Weeks (1000389) | $580.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Or First Fetus At 14 Weeks Or Greater (1000391) | $727.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Breast, Limited Study (1024606) | $427.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Single Breast, Complete Study (1024605) | $557.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Rectum (1000400) | $485.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Pelvis Through Vagina (1000396) | $691.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Head And Neck (1000379) | $696.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Female Pelvic Organs, Complete Study (1000397) | $597.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Arm Or Leg, Limited Study (1000401) | $87.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Abdomen, Limited Study (1000383) | $487.00 |
N/A
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Diagnostic Imaging - Ultrasound Of Abdomen, Complete Study (1000382) | $647.00 |
N/A
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Diagnostic Imaging - Ultrasound Measurement Of Bladder Capacity After Voiding (1007980) | $153.00 |
N/A
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Diagnostic Imaging - Ultrasound Guidance For Needle Insertion (1000409) | $218.00 |
N/A
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Diagnostic Imaging - Ultrasound Behind Abdominal Cavity, Limited Study (1000385) | $232.00 |
N/A
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Diagnostic Imaging - Ultrasound Behind Abdominal Cavity, Complete Study (1000384) | $602.00 |
N/A
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Diagnostic Imaging - Screening Ultrasound Of Abdominal Aorta To Detect Bulging (1026825) | $492.00 |
N/A
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Diagnostic Imaging - Screening Mammogram Of Both Breasts (1026824) | $406.00 |
N/A
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Diagnostic Imaging - Screening Mammogram Of Both Breasts (1026823) | $406.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Upper Spinal Canal, Without Contrast (1000223) | $2,790.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Upper Spinal Canal, With And Without Contrast (1000229) | $4,047.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Pelvis, Without Contrast (1000235) | $2,650.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Middle Spinal Canal, Without Contrast (1000225) | $2,831.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Middle Spinal Canal, With And Without Contrast (1000230) | $4,047.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Lower Spinal Canal, Without Contrast (1000227) | $2,705.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Lower Spinal Canal, With And Without Contrast (1000231) | $4,047.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg, Without Contrast (1000252) | $2,515.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg, With And Without Contrast (1000253) | $3,800.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg Joint, Without Contrast (1000254) | $2,387.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Leg Joint, With And Without Contrast (1000256) | $3,572.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Eye, Face, Or Neck, Without Contrast (1000197) | $2,721.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Eye, Face, Or Neck, With And Without Contrast (1000198) | $4,026.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Brain, Without Contrast (1000206) | $2,616.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Brain, With And Without Contrast (1000209) | $3,805.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm, Without Contrast (1000241) | $2,386.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm, With And Without Contrast (1000242) | $3,800.00 |
N/A
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Diagnostic Imaging - Mri Scan Of Arm Joint, Without Contrast (1000243) | $2,501.00 |
N/A
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Diagnostic Imaging - Mra Scan Of Blood Vessels In Neck, With And Without Contrast (1000204) | $3,494.00 |
N/A
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Diagnostic Imaging - Mra Scan Of Blood Vessels In Head, Without Contrast (1000199) | $2,418.00 |
N/A
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Diagnostic Imaging - Motion Recording Of Swallowing Function (1002498) | $623.00 |
N/A
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Diagnostic Imaging - Mammogram Of Single Breast (1026821) | $385.00 |
N/A
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Diagnostic Imaging - Mammogram Of Both Breasts (1026822) | $492.00 |
N/A
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Diagnostic Imaging - Limited Ultrasound Of One Or More Fetuses (1000393) | $410.00 |
N/A
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Diagnostic Imaging - Guidance For Procedure, Up To 1 Hour (1001223) | $246.00 |
N/A
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Diagnostic Imaging - Follow-Up Ultrasound Of Fetus (1000394) | $498.00 |
N/A
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Diagnostic Imaging - Dual-Energy X-Ray For Bone Density Study (1004466) | $478.00 |
N/A
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Diagnostic Imaging - Diagnostic Pet Scan With Ct Imaging, Whole Body (1003384) | $6,069.00 |
N/A
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Diagnostic Imaging - Diagnostic Pet Scan With Ct Imaging, Skull Base To Mid-Thigh (1003370) | $5,462.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Upper Spine, Without Contrast (1003591) | $2,385.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Pelvis, Without Contrast (1000232) | $1,659.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Pelvis, With Contrast (1000233) | $2,870.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Neck, Without Contrast (1000194) | $2,200.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Neck, With Contrast (1003594) | $2,839.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Middle Spine, Without Contrast (1000220) | $2,372.00 |
N/A
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Diagnostic Imaging - Ct Scan Of Lower Spine, Without Contrast (1000221) | $2,359.00 |
N/A
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