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 |
|---|---|---|---|---|
| Chromosome analys amniotic CPT 88269 | $13.88 | $198.25 | $173.66 – $1,828.69 | 23 |
| Chromosome analysis 100 CPT 88249 | $30.87 | $441.00 | $173.17 – $1,895.61 | 24 |
| Chromosome analysis 15-20 cell count CPT 88262 | $14.79 | $211.35 | $125.49 – $1,370.46 | 23 |
| Chromosome analysis 45 CPT 88263 | $18.44 | $263.36 | $150.29 – $1,598.84 | 23 |
| Chromosome analysis 5 CPT 88261 | $18.50 | $264.34 | $110.13 – $1,649.69 | 23 |
| Chromosome analys placenta CPT 88267 | $13.20 | $188.57 | $188.57 – $1,976.67 | 23 |
| Chromosome count additional CPT 88285 | $1.88 | $26.91 | $8.37 – $177.44 | 24 |
| Chromosome karyotype study CPT 88280 | $2.34 | $33.47 | $27.50 – $275.97 | 23 |
| Chromosome study additional CPT 88289 | $2.41 | $34.43 | $15.97 – $97.64 | 24 |
| Chronic urticaria - sendout CPT 86343 | $10.50 | $150.00 | $4.57 – $132.58 | 23 |
| Chylomicron screen, bf - sendout CPT 82664 | $5.25 | $75.00 | $6.61 – $320.69 | 23 |
| Ciprofloxacin 400 mg/200 ml in 5 % dextrose intravenous piggyback HCPCS J0744 | $15.81 | $225.93 | $4.50 – $228.64 | 10 |
| Circum 28 days or older CPT 54161 | $47.95 | $685.00 | $126.58 – $334.07 | 36 |
| Circumcise/surg/28 days or < 54160 CPT 54160 | $54.60 | $780.00 | $34.43 – $1,232.40 | 18 |
| Circumcision (newborn) CPT 54150 | $236.46 | $3,378.00 | $30.00 – $304.00 | 36 |
| C-kit mutation liquid tumor - sendout CPT 81272 | $18.45 | $263.60 | $263.60 – $2,705.17 | 23 |
| C-laminoplasty w/graft/plate CPT 63051 | $397.88 | $5,684.00 | $174.98 – $4,052.37 | 34 |
| Claviculectomy partial CPT 23120 | $146.09 | $2,087.00 | $71.85 – $1,105.77 | 34 |
| Clean out mastoid cavity CPT 69222 | $53.90 | $770.00 | $45.00 – $340.51 | 36 |
| Clearance of airways CPT 31720 | $26.60 | $380.00 | $50.63 – $577.64 | 22 |
| Clearance of tear duct CPT 68530 | $61.88 | $884.00 | $25.00 – $868.70 | 34 |
| Clindamycin 600 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J0736 | $24.41 | $348.70 | $0.65 – $21.44 | 10 |
| Clip ligating vesolock lg HCPCS C1760 | $406.91 | $5,813.00 | $1,411.00 – $1,763.75 | 4 |
| Clip phn wireless f/baha4 proc HCPCS L9900 | $174.79 | $2,497.00 | $74.00 – $620.40 | 10 |
| Clonidine (pf) 1,000 mcg/10 ml (100 mcg/ml) epidural solution HCPCS J0735 | $4.83 | $69.00 | $17.23 – $80.04 | 19 |
| Closed carpo/metacarpal disl thumb w/manip CPT 26641 | $98.21 | $1,403.00 | $11.00 – $669.16 | 34 |
| Closed treatment of femoral fracture proximal end neck; wi CPT 27232 | $175.07 | $2,501.00 | $55.00 – $1,537.64 | 34 |
| Closed tx humerus fx with manip 23605 CPT 23605 | $119.98 | $1,714.00 | $12.00 – $885.09 | 36 |
| Closed tx humerus fx without manip 23600 CPT 23600 | $87.29 | $1,247.00 | $10.00 – $595.60 | 36 |
| Closed tx humerus fx w/manip 24505 CPT 24505 | $184.87 | $2,641.00 | $269.17 – $4,241.76 | 35 |
| Closed tx metatarsophalangeal jnt disl without anes CPT 28630 | $27.23 | $389.00 | $17.00 – $258.73 | 34 |
| Closed tx orbit without manipulj CPT 21400 | $55.86 | $798.00 | $152.00 – $401.51 | 18 |
| Closed tx post hip arthroplasty disloc w/anes 27266 CPT 27266 | $143.29 | $2,047.00 | $11.00 – $1,138.99 | 34 |
| Closed tx septal&nose fx CPT 21337 | $75.60 | $1,080.00 | $130.68 – $8,745.94 | 36 |
| Closed tx sesamoid fx 28530 CPT 28530 | $27.72 | $396.00 | $15.00 – $650.69 | 36 |
| Closed tx/talus fracture without manip 28430 CPT 28430 | $62.23 | $889.00 | $152.00 – $415.05 | 36 |
| Close lac/mouth vest/2.5 cm or < 40830 CPT 40830 | $56.56 | $808.00 | $20.00 – $351.60 | 36 |
| Close tear duct opening CPT 68760 | $36.12 | $516.00 | $45.00 – $837.29 | 36 |
| Close tear duct opening CPT 68761 | $35.98 | $514.00 | $30.00 – $304.00 | 36 |
| Clostridium toxin a w/optic CPT 87803 | $1.12 | $16.00 | $2.78 – $98.83 | 23 |
| Clos txnose fx without stablz 21315 CPT 21315 | $38.85 | $555.00 | $43.00 – $467.46 | 36 |
| Closure enterostomy lg/sm intestine 44620 CPT 44620 | $203.21 | $2,903.00 | $25.00 – $1,477.07 | 34 |
| Closure enterostomy lg/sm intestine anast 44626 CPT 44626 | $368.83 | $5,269.00 | $616.00 – $2,830.85 | 34 |
| Closure enterostomy lg/sm intestine oth/thn 44625 CPT 44625 | $237.16 | $3,388.00 | $396.00 – $1,761.58 | 34 |
| Closure intestinal cutaneous fistula 44640 CPT 44640 | $324.52 | $4,636.00 | $30.00 – $2,458.62 | 34 |
| Closure laceration vestibule mouth > 2.5 cm cmplx CPT 40831 | $50.47 | $721.00 | $25.00 – $1,422.71 | 36 |
| Closure of eyelid by suture CPT 67875 | $23.38 | $334.00 | $42.07 – $344.35 | 34 |
| Closure of windpipe lesion 31820 CPT 31820 | $81.13 | $1,159.00 | $40.00 – $8,745.94 | 36 |
| Closure paravalvlr leak pq CPT 33999 | $393.47 | $5,621.00 | $827.39 – $1,654.78 | 12 |
| Clot factor fletcher fact CPT 85292 | $8.06 | $115.13 | $7.04 – $201.50 | 23 |
| Clot factor wght kininogen CPT 85293 | $12.50 | $178.50 | $7.04 – $201.50 | 23 |
| Clot factor xii hageman CPT 85280 | $1.35 | $19.35 | $7.16 – $212.75 | 23 |
| Clot factor xiii fibrin scrn CPT 85291 | $0.55 | $7.91 | $3.21 – $97.72 | 23 |
| Clot factor xiii fibrin stab CPT 85290 | $1.02 | $14.52 | $6.05 – $179.66 | 23 |
| Clsd/shoulder dislo/manip/no anest 23650 CPT 23650 | $86.10 | $1,230.00 | $152.00 – $557.63 | 35 |
| Clsd tx bimalleol ank fx without manip 27808 CPT 27808 | $87.71 | $1,253.00 | $15.00 – $607.46 | 36 |
| Clsd tx carpo/metacarpl disl thmb manip ea without anes CPT 26670 | $91.00 | $1,300.00 | $13.00 – $619.33 | 36 |
| Clsd tx clavicle dislocation without manip 23540 CPT 23540 | $61.74 | $882.00 | $152.00 – $379.45 | 18 |
| Clsd tx/clavicular fx without manip 23500 CPT 23500 | $59.85 | $855.00 | $6.00 – $393.90 | 36 |
| Clsd tx/dis phalan fx without manip/ea 26750 CPT 26750 | $50.19 | $717.00 | $17.00 – $329.83 | 36 |
| Clsd tx dist fib fx w/manip 27788 CPT 27788 | $97.65 | $1,395.00 | $220.77 – $809.16 | 36 |
| Clsd tx/dis tib/wt bear no manip 27824 CPT 27824 | $81.48 | $1,164.00 | $15.00 – $574.24 | 36 |
| Clsd tx elbow dislocation child 24640 CPT 24640 | $29.68 | $424.00 | $9.00 – $304.00 | 36 |
| Clsd tx/fem shaft fx/manipulation 27502 CPT 27502 | $182.56 | $2,608.00 | $25.00 – $1,570.86 | 34 |
| Clsd tx finger tendon w/wo perq pin 26432 CPT 26432 | $137.13 | $1,959.00 | $27.00 – $1,060.69 | 36 |
| Clsd tx fracture of radius 25500 CPT 25500 | $74.83 | $1,069.00 | $148.06 – $479.33 | 35 |
| Clsd tx/fx grt toe/phalanx/phalang 28490 CPT 28490 | $37.24 | $532.00 | $57.06 – $304.00 | 36 |
| Clsd tx/fx/phalanx/phalang/manip 28515 CPT 28515 | $42.70 | $610.00 | $20.00 – $304.00 | 36 |
| Clsd tx fx radius/ulna dist without manip 25600 CPT 25600 | $89.25 | $1,275.00 | $32.00 – $536.28 | 36 |
| Clsd tx fx radius/ulna dist w/manip 25605 CPT 25605 | $184.87 | $2,641.00 | $15.00 – $1,143.74 | 36 |
| Clsd tx fx radius/ulna without manip 25560 CPT 25560 | $76.23 | $1,089.00 | $148.97 – $486.44 | 35 |
| Clsd tx fx radius/ulna w/manip 25565 CPT 25565 | $184.87 | $2,641.00 | $10.00 – $991.87 | 36 |
| Clsd tx/grt hum tube fx without manip 23620 CPT 23620 | $70.98 | $1,014.00 | $45.79 – $484.07 | 36 |
| Clsd tx hip disloc without anes 27265 CPT 27265 | $104.79 | $1,497.00 | $11.00 – $778.31 | 34 |
| Clsd tx humeral fract without manip 24530 CPT 24530 | $99.54 | $1,422.00 | $5.00 – $695.26 | 36 |
| Clsd tx humerus fract without manip 24500 CPT 24500 | $94.50 | $1,350.00 | $152.00 – $643.06 | 36 |
| Clsd tx iphal jnt disl w/manip req anes CPT 26775 | $91.28 | $1,304.00 | $30.00 – $737.81 | 36 |
| Clsd tx mandibular fx without manip 21450 CPT 21450 | $149.59 | $2,137.00 | $152.00 – $904.07 | 30 |
| Clsd tx/metacar/interphal artic fx 26740 CPT 26740 | $61.60 | $880.00 | $17.00 – $405.77 | 36 |
| Clsd tx/metacarpal fx/sg without manip 26600 CPT 26600 | $79.31 | $1,133.00 | $6.00 – $486.44 | 36 |
| Clsd tx/metacarpal fx/sng/w manip 26605 CPT 26605 | $85.89 | $1,227.00 | $152.00 – $590.85 | 36 |
| Clsd tx metacarp fx w/manip&ext fix ea bone 26607 CPT 26607 | $126.84 | $1,812.00 | $152.00 – $920.69 | 36 |
| Clsd tx metatarsal fracture w/manip 28475 CPT 28475 | $58.38 | $834.00 | $45.00 – $650.69 | 36 |
| Clsd tx/metatarsal fx without manip 28470 CPT 28470 | $56.56 | $808.00 | $15.00 – $385.40 | 36 |
| Clsd tx/nasal bone fx/stabilize 21320 CPT 21320 | $54.25 | $775.00 | $30.00 – $450.85 | 36 |
| Clsd tx of ankle fracture w/manip 28435 CPT 28435 | $84.14 | $1,202.00 | $20.00 – $4,241.76 | 36 |
| Clsd tx patella disloc without anes 27560 CPT 27560 | $86.80 | $1,240.00 | $40.21 – $669.16 | 34 |
| Clsd tx/patellar fx without manip 27520 CPT 27520 | $84.98 | $1,214.00 | $35.00 – $590.85 | 36 |
| Clsd tx pelvic ring fx CPT 27197 | $94.43 | $1,349.00 | $50.00 – $650.69 | 36 |
| Clsd tx prox fib/shaft fx w/manip 27781 CPT 27781 | $184.73 | $2,639.00 | $83.77 – $4,241.76 | 36 |
| Clsd tx/prox/mid phalnx fx/no manp 26720 CPT 26720 | $53.20 | $760.00 | $6.00 – $351.19 | 36 |
| Clsd tx/radial head/neck fx/no manip 24650 CPT 24650 | $69.65 | $995.00 | $149.31 – $472.21 | 35 |
| Clsd tx radius fracture w/manip 24655 CPT 24655 | $103.39 | $1,477.00 | $331.63 – $4,241.76 | 35 |
| Clsd tx/scapular fx without manip 23570 CPT 23570 | $63.49 | $907.00 | $95.79 – $422.38 | 36 |
| Clsd tx shoulder dislc/fx 23665 CPT 23665 | $101.85 | $1,455.00 | $194.71 – $4,241.76 | 35 |
| Clsd tx shoulder disloc w/anatom neck fx w/manip 23675 CPT 23675 | $125.72 | $1,796.00 | $65.00 – $1,039.33 | 34 |
| Clsd tx/shoulder dislo/manip/anest 23655 CPT 23655 | $102.83 | $1,469.00 | $427.73 – $716.62 | 27 |
| Clsd tx/talotarsal dislocat/anes 28575 CPT 28575 | $87.22 | $1,246.00 | $124.35 – $563.28 | 34 |
| Clsd tx temporomandibular dislocat 21480 CPT 21480 | $35.28 | $504.00 | $14.15 – $304.00 | 36 |
| Clsd tx toe dislocation without anes28660 CPT 28660 | $132.86 | $1,898.00 | $12.00 – $191.35 | 34 |
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.