Sequoyah County-City of Sallisaw Hospital Authorit

213 East Redwood, Sallisaw, OK 74955 · (918) 774-1100

Acute Care HospitalsGovernment - LocalCMS rating 3/5Fort Smith, AR-OK metro Website ↗

Price file

Prices published

File dated 2026-02-10

383 price rows for 58 procedures

Published prices

cash · negotiated range · list

Basic metabolic panel (blood test)

CPT 80048 · metro median $19

$56

cash

$8 to $8

1 negotiated rates

$75

list

CT scan of the abdomen and pelvis, with contrast

CPT 74177 · metro median $2,734

$2,734

cash

$77 to $82

6 negotiated rates

$3,645

list

CT scan of the head, no contrast

CPT 70450 · metro median $782

$782

cash

$36 to $38

6 negotiated rates

$1,043

list

CT scan of the pelvis, with contrast

CPT 72193 · metro median $1,118

$1,118

cash

$49 to $52

6 negotiated rates

$1,491

list

Cesarean section hospital stay, no complications

MS-DRG 788

—

cash

$2,810 to $7,676

6 negotiated rates

—

list

Chlamydia test (DNA)

CPT 87491 · metro median $80

$80

cash

$31 to $31

1 negotiated rates

$106

list

Colonoscopy (diagnostic)

CPT 45378 · metro median $1,154

$1,599

cash

$84 to $293

6 negotiated rates

$2,132

list

Colonoscopy with biopsy

CPT 45380 · metro median $394

$394

cash

$183 to $372

6 negotiated rates

$525

list

Colonoscopy with polyp removal

CPT 45385 · metro median $467

$467

cash

$231 to $392

6 negotiated rates

$622

list

Complete blood count (CBC) with differential

CPT 85025 · metro median $18

$167

cash

$7 to $7

1 negotiated rates

$222

list

Comprehensive metabolic panel (blood test)

CPT 80053 · metro median $23

$81

cash

$9 to $9

1 negotiated rates

$108

list

Diagnostic mammogram (both breasts)

CPT 77066 · metro median $176

$221

cash

$42 to $42

1 negotiated rates

$295

list

Electrocardiogram (ECG) with interpretation

CPT 93000 · metro median $60

$60

cash

$12 to $12

1 negotiated rates

$80

list

Established patient office visit (about 40 minutes)

CPT 99215 · metro median $119

$309

cash

$159 to $159

1 negotiated rates

$412

list

Family psychotherapy with the patient

CPT 90847 · metro median $203

$203

cash

$94 to $103

6 negotiated rates

$271

list

Gallbladder removal (laparoscopic)

CPT 47562 · metro median $1,262

$1,262

cash

$582 to $621

6 negotiated rates

$1,683

list

Gonorrhea test (DNA)

CPT 87591 · metro median $80

$80

cash

$31 to $31

1 negotiated rates

$106

list

Group psychotherapy

CPT 90853 · metro median $53

$53

cash

$24 to $25

6 negotiated rates

$70

list

Hip or knee replacement, no major complications

MS-DRG 470

—

cash

$10,209 to $15,443

6 negotiated rates

—

list

Hospital stay for digestive disorders, no complications

MS-DRG 392

—

cash

$3,244 to $6,242

6 negotiated rates

—

list

Hysterectomy for non-cancer reasons, no complications

MS-DRG 743

—

cash

$5,668 to $9,933

6 negotiated rates

—

list

Inguinal hernia repair (age 5 and up)

CPT 49505 · metro median $800

$800

cash

$461 to $492

6 negotiated rates

$1,067

list

Left heart catheterization

CPT 93452 · metro median $4,382

$4,382

cash

$205 to $217

6 negotiated rates

$5,842

list

Lipid panel (cholesterol test)

CPT 80061 · metro median $52

$52

cash

$12 to $12

1 negotiated rates

$69

list

Liver function panel

CPT 80076 · metro median $22

$81

cash

$7 to $7

1 negotiated rates

$108

list

MRI of the brain, with and without contrast

CPT 70553 · metro median $2,926

$2,995

cash

$97 to $103

6 negotiated rates

$3,993

list

MRI of the knee or other lower joint, no contrast

CPT 73721 · metro median $1,365

$2,450

cash

$57 to $61

6 negotiated rates

$3,267

list

MRI of the lower back (lumbar spine), no contrast

CPT 72148 · metro median $1,966

$2,995

cash

$63 to $67

6 negotiated rates

$3,993

list

MRI of the neck (cervical spine), no contrast

CPT 72141 · metro median $2,153

$2,450

cash

$63 to $67

6 negotiated rates

$3,267

list

Neck (cervical) spinal fusion, no complications

MS-DRG 473

—

cash

$11,985 to $19,546

6 negotiated rates

—

list

Nerve block injection, lower back, with imaging guidance

CPT 64483 · metro median $197

$197

cash

$102 to $212

6 negotiated rates

$263

list

New patient office visit (about 30 minutes)

CPT 99203 · metro median $73

$170

cash

$98 to $98

1 negotiated rates

$227

list

New patient office visit (about 45 minutes)

CPT 99204 · metro median $99

$246

cash

$148 to $148

1 negotiated rates

$328

list

New patient office visit (about 60 minutes)

CPT 99205 · metro median $154

$320

cash

$195 to $195

1 negotiated rates

$427

list

PSA test (prostate)

CPT 84153 · metro median $50

$50

cash

$16 to $16

1 negotiated rates

$66

list

Partial thromboplastin time (blood clotting test)

CPT 85730 · metro median $27

$150

cash

$5 to $5

1 negotiated rates

$200

list

Physical therapy, therapeutic exercise (15 minutes)

CPT 97110 · metro median $72

$88

cash

$26 to $26

1 negotiated rates

$117

list

Pregnancy ultrasound (after first trimester)

CPT 76805 · metro median $261

$261

cash

$42 to $45

6 negotiated rates

$348

list

Preventive visit, new patient age 18 to 39

CPT 99385 · metro median $169

$169

cash

$114 to $114

1 negotiated rates

$225

list

Preventive visit, new patient age 40 to 64

CPT 99386 · metro median $183

$183

cash

$131 to $131

1 negotiated rates

$244

list

Prostate biopsy

CPT 55700 · metro median $3,109

$3,109

cash

$119 to $209

6 negotiated rates

$4,145

list

Prothrombin time (blood clotting test)

CPT 85610 · metro median $14

$23

cash

$4 to $4

1 negotiated rates

$31

list

Psychotherapy, 45 minutes

CPT 90834 · metro median $178

$178

cash

$90 to $94

6 negotiated rates

$237

list

Psychotherapy, 60 minutes

CPT 90837 · metro median $266

$266

cash

$132 to $138

6 negotiated rates

$355

list

Removal of a breast lump (biopsy by excision)

CPT 19120 · metro median $1,949

$1,949

cash

$385 to $453

6 negotiated rates

$2,599

list

Screening mammogram (both breasts)

CPT 77067 · metro median $105

$181

cash

$32 to $32

1 negotiated rates

$241

list

Sleep study (overnight, attended)

CPT 95810 · metro median $3,377

$4,370

cash

$105 to $111

6 negotiated rates

$5,826

list

Spinal injection, lower back, no imaging guidance

CPT 62322 · metro median $1,084

$1,084

cash

$73 to $118

6 negotiated rates

$1,445

list

Spinal injection, lower back, with imaging guidance

CPT 62323 · metro median $464

$464

cash

$92 to $221

6 negotiated rates

$618

list

TSH test (thyroid)

CPT 84443 · metro median $11

$64

cash

$15 to $15

1 negotiated rates

$85

list

Tonsils and adenoids removal (under age 12)

CPT 42820 · metro median $543

$543

cash

$259 to $275

6 negotiated rates

$724

list

Transvaginal ultrasound

CPT 76830 · metro median $185

$185

cash

$29 to $31

6 negotiated rates

$246

list

Ultrasound of the abdomen (complete)

CPT 76700 · metro median $407

$407

cash

$34 to $36

6 negotiated rates

$542

list

Upper endoscopy (EGD)

CPT 43235 · metro median $1,085

$1,085

cash

$112 to $246

6 negotiated rates

$1,446

list

Upper endoscopy with biopsy

CPT 43239 · metro median $362

$362

cash

$126 to $321

6 negotiated rates

$482

list

Urinalysis with microscope

CPT 81001 · metro median $11

$27

cash

$3 to $3

1 negotiated rates

$36

list

Vaginal delivery hospital stay, no complications

MS-DRG 807

—

cash

$1,811 to $5,398

6 negotiated rates

—

list

X-ray of the lower spine (4 or more views)

CPT 72110 · metro median $194

$194

cash

$11 to $12

6 negotiated rates

$258

list

Source files

The machine-readable files this hospital lists in its cms-hpt.txt. Every price above comes from one of them.

https://nhssequoyah.com/wp-content/uploads/2026/03/731066229_northeastern-health-system-sequoyah_standardcharges.csv
Northeastern Health System Sequoyah · failed · tall v3.0.0 · file dated 2026-02-10 · 383 price rows read · read Nov 2026