LODI MEMORIAL HOSPITAL ASSOCIATION INC
975 S Fairmont Ave, Lodi, CA · Adventisthealth · · NPI 1316938301
Published prices by procedure
Cash price is what you pay without insurance. The negotiated range spans the lowest to highest rate this hospital agreed with insurers.
| Procedure | Cash price | Gross charge | Negotiated range | Payers |
|---|---|---|---|---|
| 11-desoxycortisol - sendout CPT 82634 | $2.05 | $29.28 | $10.96 – $321.80 | 23 |
| 17-hydroxypregnenolone CPT 84143 | $1.60 | $22.81 | $8.51 – $250.95 | 23 |
| 17-ketosteroids CPT 83586 | $2.08 | $29.73 | $4.70 – $140.80 | 23 |
| 1st hosp/birthing center care per day nml nb 99460 CPT 99460 | $16.24 | $232.00 | $47.20 – $304.00 | 36 |
| 1st inpatient critical care pr day age 28 days/less than 99468 CPT 99468 | $156.17 | $2,231.00 | $152.00 – $1,601.83 | 36 |
| 1st/sbsq psyc collab care CPT 99494 | $13.79 | $197.00 | $36.25 – $82.71 | 18 |
| 2nd order venous cath CPT 36012 | $366.38 | $5,234.00 | $113.55 – $1,487.07 | 36 |
| 2vhpv vaccine 3 dose im CPT 90650 | $40.18 | $574.00 | $12.00 – $171.34 | 14 |
| 3-d radiotherapy plan CPT 77295 | $63.49 | $907.00 | $231.97 – $515.70 | 34 |
| 3d recon without postprocess indpndt CPT 76376 | $480.20 | $6,860.00 | $7.52 – $954.59 | 37 |
| 5% dextrose and 0.45% saline HCPCS S5010 | $19.40 | $277.12 | $0.88 – $396.01 | 8 |
| 5' nucleotidase - sendout CPT 83915 | $0.78 | $11.15 | $4.08 – $122.59 | 23 |
| 99381 initial comp preventive med less than 1 year new CPT 99381 | $14.00 | $200.00 | $78.63 – $304.00 | 27 |
| 99382 initial comp preventive med 1 to 4 years new CPT 99382 | $20.44 | $292.00 | $90.05 – $304.00 | 27 |
| 99383 initial comp preventive med 5 to 11 years new CPT 99383 | $24.43 | $349.00 | $90.05 – $304.00 | 27 |
| 99391 periodic comp preventive med less than 1 year est CPT 99391 | $12.04 | $172.00 | $67.58 – $304.00 | 27 |
| 99392 periodic comp preventive med 1 to 4 years est CPT 99392 | $17.64 | $252.00 | $78.63 – $304.00 | 27 |
| 99393 periodic comp preventive med 5 to 11 years est CPT 99393 | $19.67 | $281.00 | $78.63 – $304.00 | 27 |
| 99394 periodic comp preventive med 12 to 17 years est CPT 99394 | $19.67 | $281.00 | $90.05 – $304.00 | 27 |
| 99397 periodic comp preventive med 65+ years est CPT 99397 | $20.16 | $288.00 | $113.29 – $304.00 | 27 |
| #a/b/c/c/h pnl-candida albicans ab CPT 86628 | $0.84 | $12.01 | $4.39 – $136.21 | 23 |
| Abd aorta w/runoff s&i CPT 75630 | $680.82 | $9,726.00 | $49.00 – $8,329.20 | 37 |
| Abd exp/postop hem/throm/infec 35840 CPT 35840 | $282.03 | $4,029.00 | $100.52 – $2,167.66 | 36 |
| Abd/low ext cath 1st CPT 36245 | $455.63 | $6,509.00 | $95.00 – $2,356.43 | 36 |
| Abd/low ext cath 2nd CPT 36246 | $497.00 | $7,100.00 | $75.00 – $2,269.50 | 36 |
| Abd/low ext cath 3rd CPT 36247 | $617.75 | $8,825.00 | $70.00 – $3,582.69 | 36 |
| Abd/low ext cath addl CPT 36248 | $270.83 | $3,869.00 | $40.56 – $318.00 | 36 |
| Abdominal CT scan (with and without contrast) CPT 74170 | $773.78 | $11,054.00 | $36.67 – $2,376.81 | 37 |
| Abdominal CT scan (with contrast) CPT 74160 | $687.33 | $9,819.00 | $33.40 – $1,919.90 | 37 |
| Abdominal CT scan (without contrast) CPT 74150 | $636.23 | $9,089.00 | $31.15 – $1,592.05 | 37 |
| Abdominal MRI (with and without contrast) CPT 74183 | $890.40 | $12,720.00 | $59.21 – $7,085.06 | 37 |
| Abdominal MRI (with contrast) CPT 74182 | $879.27 | $12,561.00 | $45.47 – $3,829.21 | 37 |
| Abdominal MRI (without contrast) CPT 74181 | $875.84 | $12,512.00 | $38.16 – $3,135.73 | 37 |
| Abdominal paracentesis w/image guidance CPT 49083 | $348.46 | $4,978.00 | $89.72 – $647.26 | 36 |
| Abdominal Ultrasound (complete) CPT 76700 | $289.38 | $4,134.00 | $38.17 – $559.51 | 37 |
| Abdominal Ultrasound (limited) CPT 76705 | $200.34 | $2,862.00 | $27.93 – $402.88 | 37 |
| Abdominoplasty 15830 CPT 15830 | $283.43 | $4,049.00 | $648.00 – $1,803.26 | 34 |
| Abd paracentesis/w/o image guide 49082 CPT 49082 | $52.08 | $744.00 | $35.00 – $341.41 | 36 |
| Abl1 gene CPT 81170 | $51.88 | $741.13 | $300.00 – $3,524.72 | 23 |
| Ablate inf turbinate submuc 30802 CPT 30802 | $49.77 | $711.00 | $81.91 – $4,092.96 | 36 |
| Ablate inf turbinate superf 30801 CPT 30801 | $55.16 | $788.00 | $37.00 – $332.17 | 36 |
| Ablation cardiac vagal inputs atrium CPT 93799 | $423.08 | $6,044.00 | $169.72 – $3,450.00 | 15 |
| Ablation cryo abd perit om CPT 49999 | $177.87 | $2,541.00 | $38.00 – $84.00 | 9 |
| Ablation cryo pq chest wall tumor(s) w/guid CPT 23929 | $68.81 | $983.00 | $38.00 – $650.69 | 21 |
| Ablation cryo thigh/knee CPT 27599 | $53.20 | $760.00 | $35.00 – $650.69 | 21 |
| Ablation of upper extremity nerves rf CPT 64999 | $82.74 | $1,182.00 | $38.00 – $304.00 | 15 |
| Abrasion lesions add-on CPT 15787 | $4.06 | $58.00 | $10.42 – $83.94 | 36 |
| Abrasion lesion single CPT 15786 | $33.18 | $474.00 | $92.39 – $529.26 | 35 |
| Abscess drain retroperitoneal surg code CPT 49406 | $593.74 | $8,482.00 | $60.00 – $2,193.08 | 36 |
| Absorpt drg >16 <=48 without bdr HCPCS A6252 | $0.77 | $11.00 | $1.48 – $13.20 | 32 |
| Absorpt drg > 48 sq in without b HCPCS A6253 | $1.54 | $22.00 | $2.87 – $26.40 | 32 |
| Access & clsr pq fem art endogft dlvry w/img uni CPT 34713 | $6.51 | $93.00 | $21.22 – $313.43 | 34 |
| Acetaminophen 10 mg/ml soln 100 ml glass cont HCPCS J0131 | $19.08 | $272.62 | $0.07 – $389.57 | 11 |
| Acetaminophen 120 mg rectal suppository HCPCS A9270 | $7.42 | $106.00 | $0.01 – $74.00 | 9 |
| Acetaminophen level CPT 80143 | $23.38 | $334.00 | $14.91 – $69.51 | 23 |
| Acetazolamide 500 mg solution for injection HCPCS J1120 | $70.99 | $1,014.13 | $17.01 – $1,449.19 | 11 |
| Acetone qualitative CPT 82009 | $31.01 | $443.00 | $1.46 – $49.75 | 23 |
| Acetylcholine receptor modulating antibody CPT 86043 | $0.60 | $8.60 | $8.60 – $35.68 | 22 |
| Acetylcysteine 200 mg/ml (20 %) intravenous solution HCPCS J0132 | $139.93 | $1,998.94 | $0.78 – $2,856.48 | 11 |
| Acne surgery 10040 CPT 10040 | $29.12 | $416.00 | $42.65 – $304.00 | 36 |
| Aco annual medicare visit (awv), initial g0438aco HCPCS G0438 | $29.89 | $427.00 | $8.63 – $498.00 | 34 |
| Aco annual medicare visit (awv), subsq g0439aco HCPCS G0439 | $23.59 | $337.00 | $5.87 – $393.60 | 34 |
| Aco ccm; at least 20 min 99490aco CPT 99490 | $10.92 | $156.00 | $62.12 – $267.99 | 18 |
| Aco ccm; ea addl 20 min 99439aco CPT 99439 | $8.61 | $123.00 | $30.90 – $66.78 | 18 |
| Aco cmplx chron care addl 20 min 99489aco CPT 99489 | $12.88 | $184.00 | $29.88 – $140.04 | 36 |
| Aco cmplx chron care without pt visit, 60 min 99487aco CPT 99487 | $24.01 | $343.00 | $59.33 – $304.00 | 36 |
| Aco depression screen annual medicare g0444aco HCPCS G0444 | $3.15 | $45.00 | $1.24 – $98.84 | 34 |
| Aco med nutria tx/group, ea 30 min 97804aco CPT 97804 | $4.06 | $58.00 | $12.70 – $28.29 | 36 |
| Acoustic refl threshold tst CPT 92568 | $5.46 | $78.00 | $9.28 – $25.84 | 34 |
| Acromp/acromionectomy prtl CPT 23130 | $153.58 | $2,194.00 | $65.00 – $1,191.20 | 34 |
| Acup 1/> w/estim 1st 15 min CPT 97813 | $9.38 | $134.00 | $20.00 – $304.00 | 18 |
| Acup 1/> w/estim ea addl 15 CPT 97814 | $5.18 | $74.00 | $20.00 – $304.00 | 18 |
| Acup 1/> without estim ea add 15 CPT 97811 | $4.62 | $66.00 | $20.00 – $304.00 | 18 |
| Acup 1/> wo estim 1st 15 min CPT 97810 | $8.12 | $116.00 | $20.00 – $304.00 | 36 |
| Acute hepatitis panel CPT 80074 | $46.27 | $661.00 | $17.34 – $444.68 | 23 |
| Acyclovir 400 mg tablet HCPCS J8499 | $14.56 | $208.06 | $1.06 – $74.00 | 11 |
| Acyclovir 5 mg/ml in ns IV syringe (neo/ped) - cnr HCPCS J0133 | $43.79 | $625.50 | $0.06 – $546.48 | 11 |
| #acylcarnitineprfl CPT 82017 | $3.51 | $50.18 | $6.25 – $184.62 | 23 |
| Adenosine 3 mg/250 ml bag for osm HCPCS J0153 | $190.13 | $2,716.13 | $0.58 – $270.56 | 11 |
| Adenovirus antibody,serum - quest CPT 86603 | $5.53 | $79.00 | $4.72 – $141.54 | 23 |
| Adhesiolysis tube ovary 58740 CPT 58740 | $215.39 | $3,077.00 | $141.88 – $1,833.88 | 34 |
| Adh-sendout CPT 84588 | $3.15 | $45.00 | $12.75 – $374.65 | 23 |
| Adj gastric band via subq port CPT 43999 | $119.00 | $1,700.00 | $38.00 – $2,392.56 | 14 |
| Adjmt/revj ext fixj sys anes CPT 20693 | $111.51 | $1,593.00 | $35.00 – $19,141.34 | 36 |
| Adj tis trans/see area/10.1-30sqcm 14041 CPT 14041 | $187.25 | $2,675.00 | $421.82 – $5,442.78 | 36 |
| Adjustment gastric band HCPCS S2083 | $10.29 | $147.00 | $82.02 – $477.69 | 11 |
| Admelog u-100 insulin lispro 100 unit/ml subcutaneous solution HCPCS J1815 | $9.33 | $133.23 | $0.07 – $4.07 | 19 |
| Admin ecg contrast agent CPT 93352 | $10.36 | $148.00 | $34.77 – $302.67 | 37 |
| Administration chemotherapy IV infusion each additional hour CPT 96415 | $47.18 | $674.00 | $21.49 – $189.93 | 36 |
| Administration chemotherapy IV infusion each addl sequential infusion diff substance/drug >1 hr CPT 96417 | $11.06 | $158.00 | $28.59 – $165.29 | 34 |
| Administration chemotherapy IV infusion up to 1 hour single/initial substance/drug CPT 96413 | $154.14 | $2,202.00 | $28.59 – $871.32 | 36 |
| Administration chemotherapy IV push single/initial substance/drug CPT 96409 | $78.33 | $1,119.00 | $17.96 – $871.32 | 36 |
| Administration chemotherapy subcutaneous/im anti neoplastic hormonal CPT 96402 | $6.51 | $93.00 | $10.66 – $86.80 | 34 |
| Administration chemotherapy subcutaneous/im anti neoplastic non hormonal CPT 96401 | $59.43 | $849.00 | $10.66 – $189.93 | 36 |
| Administration immunization 1 vaccine CPT 90471 | $17.01 | $243.00 | $4.46 – $189.93 | 36 |
| Administration immunization each additional vaccine CPT 90472 | $2.73 | $39.00 | $11.55 – $33.98 | 36 |
| Administration immunization intranasal/oral route 1 vaccine CPT 90473 | $6.65 | $95.00 | $3.64 – $189.93 | 36 |
| Administration immunization intranasal/oral route each additional vaccine CPT 90474 | $2.59 | $37.00 | $3.64 – $33.60 | 36 |
| Administration rsv monoclonal ab seasonal dose im w/counseling CPT 96380 | $4.13 | $59.00 | $12.13 – $52.80 | 33 |
| Administration vaccine hepatitis b HCPCS G0010 | $4.34 | $62.00 | $3.23 – $74.40 | 14 |
A missing value means the hospital did not publish that price — it never means the price is zero. Real bills can add facility fees, supplies and professional fees; see our methodology.