The answer may depend upon what you want to cast and its size. Working on the basis that you are competent with one of the 3D CAD packages you could go the route Neil suggests and get a pattern made in PLA and then either investment cast or burn it out as part of the process with sand casting. You need to speak to the foundry if you go the PLA route as they will have to be happy with the process and confident they will be able to get rid of any gas produced as the pattern is burnt out. The limit with this process is going to be the size of the item you want to produce and the ability to get the patten 3D printed.
You could go the ExOne route and get the sand directly printed. When I was looking to get the forks and headstock cast for my 6" scale steam roller the quotes were eye wateringly expensive.
The other method, which was the one I went for, was to use Polystyrene patterns. I emailed of an STL file and 4 weeks later collected some very big heavy castings. In this process the pattern is CNC machined from lumps of poly which are glued together to make the final item. Undercuts can be accommodated as can other features which would have traditionally needed a core box. Use one of the specialist companies as the process has its challenges and not all foundries will cast from poly patterns. Again getting rid of the gas as the pattern is burnt out can be a challenge and lead to porosity if not done properly. Finish could also be issue, if you need a good finish on as cast surfaces be prepared to put some effort in to cleaning the casting up.