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 |
|---|---|---|---|---|
| Diagnostic digital breast tomosynthesis bil CPT 77062 | $4.90 | $70.00 | $51.96 – $132.65 | 15 |
| Diagnostic digital breast tomosynthesis unil CPT 77061 | $4.90 | $70.00 | $44.60 – $169.06 | 15 |
| Diagnostic laryngoscopy 31505 CPT 31505 | $22.75 | $325.00 | $5.00 – $304.00 | 36 |
| Diagnostic laryngoscopy 31575 CPT 31575 | $31.92 | $456.00 | $62.13 – $304.00 | 36 |
| Diagnostic Mammogram (both breasts) CPT 77066 | $12.95 | $185.00 | $47.18 – $177.64 | 34 |
| Diagnostic Mammogram (one breast) CPT 77065 | $10.50 | $150.00 | $38.35 – $140.50 | 34 |
| Diagnostic radio unlisted proc CPT 76499 | $3.50 | $50.00 | $65.14 – $229.57 | 17 |
| Dialysis circuit perm vascular embolization 36909 CPT 36909 | $864.43 | $12,349.00 | $169.42 – $5,424.37 | 36 |
| Dialysis one evaluation CPT 90945 | $90.44 | $1,292.00 | $103.51 – $1,100.71 | 21 |
| Diatrizoate meglumine 18 % urethral solution HCPCS Q9958 | $0.19 | $2.70 | $0.06 – $3.86 | 10 |
| Diazepam 5 mg/ml injection solution (wrapper) HCPCS J3360 | $59.71 | $852.93 | $1.85 – $24.36 | 19 |
| Dicyclomine injection HCPCS J0500 | $145.95 | $2,085.00 | $7.84 – $2,979.47 | 11 |
| Diffusing capacity CPT 94729 | $87.08 | $1,244.00 | $9.29 – $313.40 | 37 |
| Digoxin 250 mcg/ml (0.25 mg/ml) injection solution HCPCS J1160 | $14.49 | $207.02 | $0.98 – $295.83 | 11 |
| Digoxin total therapeutic drug level CPT 80162 | $50.54 | $722.00 | $4.87 – $145.98 | 23 |
| Dihydroergotamine 0.05 mg/ml IV syringe - cnr HCPCS J1110 | $120.96 | $1,727.94 | $15.53 – $140.36 | 19 |
| Dilate biliary duct/ampulla CPT 47542 | $31.29 | $447.00 | $114.98 – $1,754.47 | 34 |
| Dilate esophagus CPT 43453 | $20.79 | $297.00 | $15.00 – $480.94 | 34 |
| Dilate esophagus 1/mult pass CPT 43450 | $47.04 | $672.00 | $10.00 – $304.00 | 36 |
| Dilate tear duct opening CPT 68801 | $23.94 | $342.00 | $75.66 – $304.00 | 36 |
| Dilate urethra stricture CPT 53600 | $21.70 | $310.00 | $10.00 – $304.00 | 36 |
| Dilate urethra stricture CPT 53601 | $21.28 | $304.00 | $10.00 – $304.00 | 36 |
| Dilate urethra stricture CPT 53605 | $14.98 | $214.00 | $15.00 – $9,298.64 | 36 |
| Dilate urethra stricture CPT 53621 | $40.04 | $572.00 | $10.00 – $304.00 | 36 |
| Dilation/female urethra/initial 53660 CPT 53660 | $18.90 | $270.00 | $15.00 – $304.00 | 36 |
| Dilation of anal sphincter CPT 45905 | $41.58 | $594.00 | $150.78 – $282.73 | 34 |
| Dilation of cervical canal 57800 CPT 57800 | $19.04 | $272.00 | $34.46 – $304.00 | 36 |
| Dilation of rectal stricture 45910 CPT 45910 | $46.97 | $671.00 | $45.00 – $335.74 | 34 |
| Dilation of urethra CPT 53661 | $18.62 | $266.00 | $15.00 – $304.00 | 36 |
| Dilation of vagina CPT 57400 | $30.87 | $441.00 | $17.00 – $284.16 | 34 |
| Dilation salivary duct 42650 CPT 42650 | $18.48 | $264.00 | $30.16 – $304.00 | 36 |
| Dilation/urethral strict/male/ini 53620 CPT 53620 | $78.61 | $1,123.00 | $15.00 – $304.00 | 36 |
| Dilator fascial 10fx20cm HCPCS C2627 | $103.18 | $1,474.00 | $1,474.00 – $2,106.35 | 5 |
| Dilat xst trc ndurlgc px CPT 50436 | $643.44 | $9,192.00 | $131.42 – $9,298.64 | 36 |
| Dilat xst trc new access rcs CPT 50437 | $738.15 | $10,545.00 | $219.09 – $9,298.64 | 18 |
| Diltiazem 5 mg/ml intravenous solution HCPCS J1163 | $14.57 | $208.17 | $0.04 – $228.64 | 10 |
| Dimethyl sulfoxide 50% 50 ml HCPCS J1212 | $98.42 | $1,406.00 | $748.84 – $1,687.20 | 18 |
| Diphenhydramine 50 mg/ml injection (wrapper) HCPCS J1200 | $10.31 | $147.26 | $0.75 – $15.08 | 19 |
| Diphtheria-tetanus toxoids 0.5 ml (peds) CPT 90702 | $7.84 | $112.00 | $7.07 – $81.47 | 14 |
| Disability dlco CPT 94727 | $60.13 | $859.00 | $12.33 – $569.59 | 37 |
| Disaccharidases CPT 82657 | $23.58 | $336.80 | $6.71 – $197.73 | 23 |
| Discography cerv/thor spine CPT 72285 | $15.40 | $220.00 | $49.94 – $5,151.14 | 37 |
| Dise eval slp do brth flx dx CPT 42975 | $23.38 | $334.00 | $30.00 – $175.02 | 33 |
| Diverticulectomy/hypophar/esoph 43130 CPT 43130 | $190.12 | $2,716.00 | $435.00 – $1,442.35 | 34 |
| Division of fallopian tube 58605 CPT 58605 | $81.06 | $1,158.00 | $71.00 – $691.98 | 34 |
| Dmd dup/delet analysis CPT 81161 | $19.53 | $279.00 | $155.46 – $1,854.67 | 23 |
| Dmpk gene detc abnor allele CPT 81234 | $7.67 | $109.60 | $109.60 – $896.54 | 23 |
| Dna antibody native/double stranded CPT 86225 | $1.82 | $26.02 | $5.03 – $151.09 | 23 |
| Dna gardnerella CPT 87510 | $1.40 | $20.05 | $7.45 – $213.35 | 23 |
| Dna probe chlamydia CPT 87490 | $1.59 | $22.75 | $7.45 – $213.35 | 23 |
| Dna trichomonas CPT 87660 | $1.40 | $20.05 | $4.92 – $221.27 | 23 |
| Dobutamine 250 mg/20 ml (12.5 mg/ml) intravenous solution HCPCS J1250 | $88.25 | $1,260.69 | $6.24 – $1,012.48 | 11 |
| Docetaxel 20 mg/ml intravenous solution (wrapper) HCPCS J9171 | $2.38 | $34.00 | $0.60 – $40.80 | 18 |
| Dopamine 40 mg/ml intravenous solution (wrapper) HCPCS J1265 | $43.71 | $624.49 | $0.18 – $640.59 | 11 |
| Doppler echo complete CPT 93320 | $144.41 | $2,063.00 | $17.87 – $593.22 | 37 |
| Doppler intravascular pressure flow initial vessel CPT 93571 | $752.50 | $10,750.00 | $90.39 – $265.04 | 34 |
| Doppler upper/lower extremity arteries complete bilateral CPT 93923 | $261.45 | $3,735.00 | $21.15 – $786.76 | 37 |
| Doppler upper/lower extremity arteries limited bilateral CPT 93922 | $105.42 | $1,506.00 | $11.62 – $416.93 | 37 |
| Doxycycline hyclate 100 mg intravenous powder for solution HCPCS J1271 | $42.31 | $604.43 | $0.11 – $863.72 | 10 |
| Dpyd gene common variants CPT 81232 | $12.24 | $174.81 | $139.85 – $1,375.57 | 23 |
| Drainage absc/cyst/hmtma/vestibule mouth smpl CPT 40800 | $30.31 | $433.00 | $45.00 – $1,868.00 | 36 |
| Drainage ext aud canal abscess 69020 CPT 69020 | $81.20 | $1,160.00 | $15.00 – $356.22 | 36 |
| Drainage external ear complex 69005 CPT 69005 | $54.18 | $774.00 | $30.00 – $332.65 | 36 |
| Drainage external ear simple 69000 CPT 69000 | $46.06 | $658.00 | $15.00 – $304.00 | 36 |
| Drainage lymph node lesion 38305 CPT 38305 | $119.56 | $1,708.00 | $17.00 – $946.11 | 34 |
| Drainage mouth roof lesion CPT 42000 | $27.23 | $389.00 | $20.00 – $624.79 | 36 |
| Drainage of arm bursa 23931 CPT 23931 | $314.30 | $4,490.00 | $113.92 – $571.87 | 36 |
| Drainage of bone lesion CPT 26992 | $244.58 | $3,494.00 | $193.97 – $1,922.05 | 34 |
| Drainage of bone lesion CPT 27303 | $157.85 | $2,255.00 | $607.12 – $1,260.01 | 34 |
| Drainage of eye CPT 65800 | $21.42 | $306.00 | $40.00 – $6,087.86 | 36 |
| Drainage of eye CPT 65810 | $113.89 | $1,627.00 | $40.00 – $811.31 | 34 |
| Drainage of forearm bursa CPT 25031 | $93.03 | $1,329.00 | $55.00 – $913.57 | 34 |
| Drainage of kidney lesion CPT 50390 | $476.98 | $6,814.00 | $70.74 – $1,868.00 | 36 |
| Drainage of mouth lesion CPT 41005 | $29.54 | $422.00 | $20.00 – $293.24 | 34 |
| Drainage of mouth lesion CPT 41006 | $58.03 | $829.00 | $44.30 – $516.97 | 34 |
| Drainage of mouth lesion CPT 41007 | $55.65 | $795.00 | $25.00 – $4,092.96 | 36 |
| Drainage of mouth lesion CPT 41008 | $65.03 | $929.00 | $40.00 – $8,745.94 | 36 |
| Drainage of mouth lesion CPT 41009 | $71.47 | $1,021.00 | $229.34 – $554.04 | 34 |
| Drainage of mouth lesion CPT 41015 | $75.04 | $1,072.00 | $45.00 – $603.90 | 34 |
| Drainage of mouth lesion CPT 41016 | $86.03 | $1,229.00 | $50.00 – $626.59 | 34 |
| Drainage of mouth lesion CPT 41017 | $115.92 | $1,656.00 | $25.00 – $628.29 | 34 |
| Drainage of mouth lesion CPT 41018 | $99.54 | $1,422.00 | $45.00 – $728.72 | 34 |
| Drainage of nose lesion int 30000 CPT 30000 | $66.64 | $952.00 | $47.00 – $350.49 | 36 |
| Drainage of nose lesion sept 30020 CPT 30020 | $66.78 | $954.00 | $17.00 – $304.00 | 36 |
| Drainage of pelvis bursa CPT 26991 | $128.59 | $1,837.00 | $299.70 – $4,241.76 | 36 |
| Drainage of pelvis lesion 26990 CPT 26990 | $167.37 | $2,391.00 | $45.00 – $8,631.30 | 36 |
| Drainage of rectal abscess CPT 45005 | $40.95 | $585.00 | $20.00 – $388.80 | 34 |
| Drainage of rectal abscess 45020 CPT 45020 | $138.67 | $1,981.00 | $40.58 – $874.68 | 34 |
| Drainage of throat abscess CPT 42725 | $193.76 | $2,768.00 | $612.43 – $1,462.85 | 34 |
| Drainage of urethra abscess 53060 CPT 53060 | $39.97 | $571.00 | $147.96 – $5,514.28 | 36 |
| Drain bladder by trocar/cath CPT 51101 | $11.97 | $171.00 | $13.00 – $2,265.30 | 36 |
| Drain blood from under nail 11740 CPT 11740 | $14.91 | $213.00 | $19.59 – $304.00 | 36 |
| Drain cath image guided peri/retroperitoneal transvag/transrectal CPT 49407 | $47.88 | $684.00 | $109.00 – $1,837.45 | 34 |
| Drain cath image guided visceral pq CPT 49405 | $977.34 | $13,962.00 | $35.00 – $4,356.78 | 36 |
| Drain cerebro spinal fluid 62272 CPT 62272 | $124.81 | $1,783.00 | $80.13 – $318.69 | 36 |
| Drain chest lesion CPT 21502 | $120.82 | $1,726.00 | $15.00 – $1,041.70 | 34 |
| Drain finger abscess;simple 26010 CPT 26010 | $84.77 | $1,211.00 | $6.00 – $519.67 | 36 |
| Drain lower leg bursa CPT 27604 | $81.69 | $1,167.00 | $20.00 – $8,631.30 | 36 |
| Drain lower leg lesion 27603 CPT 27603 | $330.40 | $4,720.00 | $45.00 – $996.62 | 36 |
| Drain neck/chest lesion 21501 CPT 21501 | $330.40 | $4,720.00 | $10.00 – $7,662.42 | 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.