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 |
|---|---|---|---|---|
| Decomp forearm 1 space 25020 CPT 25020 | $183.82 | $2,626.00 | $60.00 – $1,191.20 | 34 |
| Decomp forearm 2 spaces w/debrid 25025 CPT 25025 | $296.73 | $4,239.00 | $25.00 – $2,213.92 | 34 |
| Decompress fasciotomyhand 26037 CPT 26037 | $139.30 | $1,990.00 | $310.50 – $1,110.52 | 34 |
| Decompress fingers/hand CPT 26035 | $212.03 | $3,029.00 | $818.32 – $1,547.13 | 34 |
| Decompress forearm 1 space CPT 25023 | $321.93 | $4,599.00 | $97.17 – $2,247.14 | 34 |
| Decompress forearm 2 spaces CPT 25024 | $190.33 | $2,719.00 | $60.00 – $1,461.71 | 34 |
| Decompression fasct forearm CPT 24495 | $227.43 | $3,249.00 | $35.00 – $1,368.62 | 34 |
| Decompression of leg CPT 27892 | $131.32 | $1,876.00 | $70.00 – $1,079.67 | 34 |
| Decompression of leg CPT 27893 | $152.11 | $2,173.00 | $40.00 – $1,074.92 | 34 |
| Decompression of leg CPT 27894 | $196.07 | $2,801.00 | $45.00 – $1,639.67 | 34 |
| Decompression of lower leg CPT 27600 | $96.60 | $1,380.00 | $231.20 – $840.01 | 34 |
| Decompression of lower leg CPT 27601 | $107.24 | $1,532.00 | $86.75 – $861.36 | 34 |
| Decompression of thigh/knee CPT 27498 | $162.54 | $2,322.00 | $356.66 – $1,174.59 | 34 |
| Decompression of tibia nerve CPT 28035 | $89.88 | $1,284.00 | $350.89 – $870.52 | 34 |
| Decompression unspecified nerve 64722 CPT 64722 | $91.21 | $1,303.00 | $375.74 – $771.88 | 27 |
| Decompres spinal cord;thoracic 63055 CPT 63055 | $378.70 | $5,410.00 | $866.00 – $3,921.98 | 34 |
| Decompress small bowel CPT 44021 | $227.71 | $3,253.00 | $379.00 – $1,678.60 | 34 |
| Decompress spinal cord lmbr CPT 63056 | $348.95 | $4,985.00 | $1,136.26 – $3,648.17 | 34 |
| Decompress spinal cord thrc CPT 63064 | $411.67 | $5,881.00 | $70.00 – $4,326.17 | 34 |
| Decompress spine cord add-on CPT 63066 | $45.99 | $657.00 | $45.00 – $518.93 | 34 |
| Decomp spinal cord/transped/ad seg 63057 CPT 63057 | $73.01 | $1,043.00 | $40.00 – $839.68 | 34 |
| Deep muscle biopsy 20205 CPT 20205 | $74.13 | $1,059.00 | $142.87 – $493.56 | 35 |
| Degarelix 120 mg subcutaneous solution HCPCS J9155 | $0.63 | $9.00 | $4.45 – $10.44 | 18 |
| Delay flap eye/nos/ear/lip CPT 15630 | $85.75 | $1,225.00 | $30.00 – $5,442.78 | 36 |
| Delay flap fccnaxghf 15620 CPT 15620 | $81.48 | $1,164.00 | $35.00 – $687.73 | 34 |
| Delivery of placenta 59414 CPT 59414 | $302.47 | $4,321.00 | $30.00 – $8,539.30 | 36 |
| Delivery only failed vbac 59620 CPT 59620 | $212.03 | $3,029.00 | $186.50 – $2,115.57 | 34 |
| Delivery only/pp care/failed vbac 59622 CPT 59622 | $316.75 | $4,525.00 | $1,183.23 – $5,430.00 | 34 |
| Demonstration/evaluation utilization aersol generator/nebulizer/metered dose inhaler/ippb device CPT 94664 | $34.37 | $491.00 | $8.60 – $577.64 | 37 |
| Denosumab 120 mg/1.7 ml (70 mg/ml) subcutaneous solution HCPCS J0897 | $1,725.02 | $24,643.15 | $10.41 – $60.20 | 31 |
| Dentoalveolar/drain abs/cyst/hema 41800 CPT 41800 | $39.97 | $571.00 | $38.00 – $350.97 | 36 |
| Depo-estradiol cypionate inj HCPCS J1000 | $4.34 | $62.00 | $38.46 – $74.40 | 18 |
| Dermabrasion segmental face 15781 CPT 15781 | $104.16 | $1,488.00 | $168.65 – $1,868.00 | 36 |
| Derm autograft face/nck/hf/g CPT 15135 | $184.80 | $2,640.00 | $133.66 – $9,348.08 | 36 |
| Design mlc device for imrt CPT 77338 | $63.49 | $907.00 | $232.34 – $2,660.65 | 37 |
| Desmopressin 4 mcg/ml injection solution HCPCS J2597 | $48.20 | $688.56 | $7.67 – $255.71 | 10 |
| Desoxycorticosterone CPT 82633 | $2.22 | $31.75 | $9.96 – $329.57 | 23 |
| Dest mal lesion feenlm <0.5cm 17280 CPT 17280 | $35.42 | $506.00 | $43.93 – $304.00 | 36 |
| Dest mal lesion feenlm 0.6-1cm 17281 CPT 17281 | $45.01 | $643.00 | $30.00 – $304.00 | 36 |
| Dest mal lesion feenlm 1.1 - 2.0 cm 17282 CPT 17282 | $51.31 | $733.00 | $50.00 – $314.55 | 36 |
| Dest mal lesion snhfg <0.5cm 17270 CPT 17270 | $37.59 | $537.00 | $48.03 – $304.00 | 36 |
| Dest mal lesion snhfg 0.6-1cm 17271 CPT 17271 | $41.79 | $597.00 | $50.00 – $304.00 | 36 |
| Dest mal lesion snhfg 1.1-2cm 17272 CPT 17272 | $47.11 | $673.00 | $25.00 – $304.00 | 36 |
| Dest mal lesion tal <0.5 17260 CPT 17260 | $24.99 | $357.00 | $37.60 – $304.00 | 36 |
| Dest mal lesion tal 0.6-1.0cm 17261 CPT 17261 | $37.31 | $533.00 | $43.93 – $304.00 | 36 |
| Dest mal lesion tal 1.1-2.0cm 17262 CPT 17262 | $44.66 | $638.00 | $30.00 – $304.00 | 36 |
| Dest mal lesion tal 2.1-3.0cm 17263 CPT 17263 | $48.30 | $690.00 | $30.00 – $304.00 | 36 |
| Destroy cervthor facet jnt 64633 CPT 64633 | $46.62 | $666.00 | $45.00 – $5,151.14 | 36 |
| Destroy cth facet jnt addl 64634 CPT 64634 | $15.96 | $228.00 | $15.00 – $502.80 | 36 |
| Destroy internal hemorrhoids destroy 46930 CPT 46930 | $38.50 | $550.00 | $20.00 – $488.41 | 34 |
| Destroy premlg lesns;1st lesn 17000 CPT 17000 | $23.03 | $329.00 | $49.67 – $304.00 | 36 |
| Destroy vulva lesion extensive 56515 CPT 56515 | $67.83 | $969.00 | $10.00 – $460.44 | 36 |
| Destroy vulva lesion simple 56501 CPT 56501 | $211.19 | $3,017.00 | $80.06 – $304.00 | 36 |
| Destruct ben lesion 15/> 17111 CPT 17111 | $33.53 | $479.00 | $76.90 – $304.00 | 36 |
| Destruct cut vasl lesions 10-50cm 17107 CPT 17107 | $112.28 | $1,604.00 | $8.00 – $1,180.22 | 36 |
| Destruct cut vasl lesions <10cm 17106 CPT 17106 | $86.24 | $1,232.00 | $8.00 – $662.90 | 36 |
| Destruction 2-14 lesions 17003 CPT 17003 | $1.89 | $27.00 | $1.72 – $13.00 | 36 |
| Destruction anal lesion(s) CPT 46910 | $211.19 | $3,017.00 | $35.00 – $5,442.78 | 36 |
| Destruction anal lesion(s) CPT 46924 | $322.98 | $4,614.00 | $35.00 – $7,321.98 | 36 |
| Destruction anal lesion(s) smpl chem 46900 CPT 46900 | $60.90 | $870.00 | $30.00 – $304.00 | 36 |
| Destruction benign lesions < 14 lesions CPT 17110 | $28.77 | $411.00 | $65.35 – $304.00 | 36 |
| Destruction by injection tx of nerve 64630 CPT 64630 | $63.14 | $902.00 | $98.29 – $304.00 | 18 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral additional (both sides) CPT 64636 | $14.00 | $200.00 | $20.00 – $452.94 | 36 |
| Destruction by neurolytic agent w/imaging guidance lumbar/sacral (both sides) CPT 64635 | $70.00 | $1,000.00 | $175.65 – $5,151.14 | 36 |
| Destruction cryosurgery anal lesion(s) simpl 46916 CPT 46916 | $65.03 | $929.00 | $88.98 – $318.07 | 36 |
| Destruction mal lsn s/n/h/f/g 2.1-3cm CPT 17273 | $52.29 | $747.00 | $50.00 – $319.75 | 36 |
| Destruction mal lsn s/n/h/f/g 3.1-4cm CPT 17274 | $60.97 | $871.00 | $100.52 – $384.74 | 36 |
| Destruction mal lsn t/a/l 3.1-4cm CPT 17264 | $51.80 | $740.00 | $75.20 – $304.00 | 18 |
| Destruction mal lsn t/a/l >4cm CPT 17266 | $58.80 | $840.00 | $90.47 – $304.00 | 18 |
| Destruction penis lesion(s) chem 54050 CPT 54050 | $46.13 | $659.00 | $5.00 – $304.00 | 36 |
| Destruction penis lesion(s) exten 54065 CPT 54065 | $56.07 | $801.00 | $40.00 – $341.97 | 36 |
| Destruction premal lesions 15/> 17004 CPT 17004 | $46.13 | $659.00 | $84.82 – $304.00 | 36 |
| Destruction rectal tumor 45190 CPT 45190 | $169.61 | $2,423.00 | $50.00 – $1,133.11 | 34 |
| Destruction vag lesions complex 57065 CPT 57065 | $60.34 | $862.00 | $15.00 – $405.19 | 36 |
| Destruction vag lesions simple 57061 CPT 57061 | $41.51 | $593.00 | $58.78 – $304.00 | 36 |
| Destruct penis les/smp/electrodesi 54055 CPT 54055 | $24.15 | $345.00 | $89.34 – $5,442.78 | 36 |
| Detect agent nos dna dir CPT 87797 | $2.10 | $30.03 | $7.45 – $213.35 | 23 |
| Determine refractive state CPT 92015 | $4.62 | $66.00 | $11.03 – $304.00 | 27 |
| Developmental screen/score/document 96110 CPT 96110 | $18.76 | $268.00 | $11.32 – $466.37 | 16 |
| Devel tst phys/qhp 1st hr CPT 96112 | $20.79 | $297.00 | $107.77 – $350.35 | 36 |
| Device ablt adv novasure HCPCS C1886 | $789.11 | $11,273.00 | $74.00 – $4,020.79 | 11 |
| Device hemospray 7frx220cm endo hemostat min access HCPCS C1052 | $1,050.00 | $15,000.00 | $15,000.00 – $21,435.00 | 5 |
| Device intraute mirena HCPCS J7298 | $268.22 | $3,831.74 | $453.61 – $3,896.40 | 19 |
| Device sut capio slim opn HCPCS C2631 | $662.83 | $9,469.00 | $4,377.00 – $5,471.25 | 4 |
| Dev interrog remote 1/2/mlt CPT 93295 | $10.50 | $150.00 | $36.70 – $478.96 | 37 |
| Dexa bone density study >=1 sites appendicular skeleton (peripheral) CPT 77081 | $2.59 | $37.00 | $9.54 – $30.12 | 34 |
| Dexamethasone 4 mg tablet HCPCS J8540 | $1.28 | $18.24 | $0.01 – $4.64 | 19 |
| Dexamethasone in ns IV syringe 0.1 mg/ml (neonate) - cnr HCPCS J1100 | $17.15 | $245.06 | $0.09 – $19.72 | 19 |
| Dextrose 5 % and 0.9 % sodium chloride intravenous solution HCPCS J7042 | $18.50 | $264.28 | $1.60 – $303.03 | 11 |
| Dextrose 5 % and lactated ringers intravenous solution HCPCS J7121 | $18.72 | $267.41 | $0.54 – $382.13 | 11 |
| Dextrose 5 % in water (d5w) intravenous solution (non-pvc) HCPCS J7060 | $14.05 | $200.65 | $2.31 – $286.73 | 11 |
| Dextrose 5 % IV bolus HCPCS J7070 | $17.38 | $248.34 | $4.63 – $236.76 | 11 |
| Dhea-s (dehydroepiand sulfate) CPT 82627 | $22.40 | $320.00 | $8.29 – $244.44 | 23 |
| Diabetes (HbA1c) Test CPT 83036 | $85.40 | $1,220.00 | $3.53 – $96.07 | 36 |
| Diabetes training group per 30 min g0109 HCPCS G0136 | $3.43 | $49.00 | $49.00 – $304.00 | 17 |
| Diab manage trn ind/group HCPCS G0109 | $4.13 | $59.00 | $16.72 – $93.00 | 21 |
| Diag laparo separate proc 49320 CPT 49320 | $78.47 | $1,121.00 | $125.00 – $678.73 | 34 |
| Diagnostic anoscopy CPT 46601 | $22.47 | $321.00 | $85.67 – $50,801.27 | 27 |
| Diagnostic anoscopy & biopsy CPT 46607 | $29.54 | $422.00 | $10.00 – $70,624.37 | 34 |
| Diagnostic anoscopy spx 46600 CPT 46600 | $29.05 | $415.00 | $15.00 – $304.00 | 36 |
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.