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 |
|---|---|---|---|---|
| Drain ovarn cyst abd CPT 58805 | $103.18 | $1,474.00 | $71.00 – $823.53 | 34 |
| Drain penis lesion CPT 54015 | $73.29 | $1,047.00 | $45.00 – $4,356.78 | 36 |
| Drain shoulder bone lesion CPT 23035 | $167.16 | $2,388.00 | $35.00 – $1,392.89 | 34 |
| Drain shoulder lesion CPT 23030 | $62.51 | $893.00 | $245.22 – $7,662.42 | 36 |
| Drain thigh/knee lesion 27301 CPT 27301 | $330.40 | $4,720.00 | $70.36 – $1,305.10 | 36 |
| Drain to peritoneal cavity CPT 49062 | $181.23 | $2,589.00 | $60.00 – $1,313.48 | 34 |
| Dress/debride pt-tck burn/5-10% bs 16025 CPT 16025 | $74.76 | $1,068.00 | $86.51 – $304.00 | 35 |
| Dress/debride pt-thick burn/<5% bs 16020 CPT 16020 | $81.13 | $1,159.00 | $31.65 – $304.00 | 36 |
| Dress/debrid prtl-thick burn l 16030 CPT 16030 | $101.64 | $1,452.00 | $16.00 – $304.00 | 36 |
| Dressing change not for burn w/anes 15852 CPT 15852 | $10.43 | $149.00 | $10.00 – $79.95 | 34 |
| Drng appendix abscess open 44900 CPT 44900 | $184.24 | $2,632.00 | $65.00 – $1,289.77 | 34 |
| Drng hand tendon sheath 26020 CPT 26020 | $139.16 | $1,988.00 | $256.14 – $8,631.30 | 36 |
| Drng of eyelid abscess 67700 CPT 67700 | $111.16 | $1,588.00 | $45.00 – $537.39 | 36 |
| Drng of finger abscess comp 26011 CPT 26011 | $187.04 | $2,672.00 | $152.00 – $806.79 | 35 |
| Drng of hydrocele 55000 CPT 55000 | $81.20 | $1,160.00 | $55.00 – $304.00 | 36 |
| Drng of mouth lesion 40801 CPT 40801 | $50.19 | $717.00 | $45.00 – $454.77 | 34 |
| Drng of ovarian cyst(s) 58800 CPT 58800 | $76.58 | $1,094.00 | $36.00 – $665.67 | 34 |
| Drng of palm multi bursas 26030 CPT 26030 | $122.78 | $1,754.00 | $472.35 – $8,631.30 | 36 |
| Drng of palm single bursa 26025 CPT 26025 | $104.65 | $1,495.00 | $260.24 – $8,631.30 | 36 |
| Drng of pelvic abscess transrectal 45000 CPT 45000 | $103.95 | $1,485.00 | $45.00 – $682.52 | 34 |
| Drng of salivary cyst 42409 CPT 42409 | $98.28 | $1,404.00 | $30.00 – $470.01 | 36 |
| Drng of scrotum abscess 55100 CPT 55100 | $57.33 | $819.00 | $30.00 – $394.58 | 36 |
| Drng open retroperitoneal abscess 49060 CPT 49060 | $259.21 | $3,703.00 | $60.00 – $1,913.32 | 34 |
| Drng open subdiaphragmatic/subphrenic absc 49040 CPT 49040 | $236.18 | $3,374.00 | $101.27 – $1,707.05 | 34 |
| Drng peritoneal abscess open 49020 CPT 49020 | $372.96 | $5,328.00 | $60.00 – $2,887.34 | 36 |
| Drng salivary gland simple 42300 CPT 42300 | $38.71 | $553.00 | $74.09 – $4,092.96 | 36 |
| Droperidol 2.5 mg/ml injection solution HCPCS J1790 | $19.51 | $278.77 | $2.76 – $398.36 | 11 |
| Drsg interceed 3x4in adh wnd barr absorb HCPCS C1765 | $493.36 | $7,048.00 | $3,205.00 – $4,006.25 | 4 |
| Drsg oasis burn wound matrix 3x3.5cm 10.5sqcm-q4103-cost per sq cm HCPCS Q4103 | $18.20 | $260.00 | $1.49 – $346.14 | 22 |
| Drsg oasis fen mesh thick 3x7cm 21sqcm -cost per sq cm HCPCS Q4102 | $13.02 | $186.00 | $1.63 – $346.14 | 22 |
| Drsg wnd hyalomatrix 10x10cm -cost per sq cm HCPCS Q4117 | $24.08 | $344.00 | $8.71 – $346.14 | 22 |
| Drug admin & hemodynmic meas CPT 93463 | $16.80 | $240.00 | $83.02 – $294.13 | 34 |
| Drug assay caffeine CPT 80155 | $2.70 | $38.57 | $21.21 – $89.57 | 23 |
| Drug assay posaconazole CPT 80187 | $1.52 | $21.69 | $21.69 – $101.12 | 23 |
| Drug assay rufinamide CPT 80210 | $1.06 | $15.14 | $15.14 – $101.12 | 23 |
| Drug assay vedolizumab CPT 80280 | $14.00 | $200.00 | $38.57 – $143.91 | 23 |
| Drug assay voriconazole CPT 80285 | $1.90 | $27.11 | $21.69 – $101.12 | 23 |
| Drug asy hydroxychloroquine CPT 80220 | $16.10 | $230.00 | $18.64 – $55.22 | 22 |
| Drug of abuse screen urine CPT 80305 | $3.50 | $50.00 | $5.73 – $109.46 | 36 |
| Drug screening tapentadol CPT 80372 | $1.51 | $21.51 | $0.03 – $204.39 | 8 |
| Drug screen quant tiagabine CPT 80199 | $4.83 | $69.00 | $27.07 – $114.30 | 23 |
| Drug test prsmv instrmnt CPT 80306 | $42.98 | $614.00 | $17.14 – $162.19 | 23 |
| Drug test(s) presumptive any class instrument chemistry analyzers CPT 80307 | $19.43 | $277.55 | $15.22 – $648.70 | 23 |
| Drvvt confirm - quest CPT 85597 | $1.12 | $15.98 | $6.66 – $167.89 | 23 |
| Dry needling (97799) CPT 97799 | $5.46 | $78.00 | $38.00 – $93.60 | 9 |
| Dstrj nulyt agt gnclr nrv CPT 64624 | $35.63 | $509.00 | $20.00 – $912.11 | 34 |
| Dstr mal les s/n/h/f/g >4.0 CPT 17276 | $70.42 | $1,006.00 | $124.72 – $454.93 | 36 |
| Dstr mal ls f/e/e/n/l/m2.1-3 CPT 17283 | $60.55 | $865.00 | $55.00 – $384.74 | 36 |
| Dstr mal ls f/e/e/n/l/m3.1-4 CPT 17284 | $68.60 | $980.00 | $133.66 – $304.00 | 18 |
| Dstr mal ls f/e/e/n/l/m>4.0 CPT 17286 | $66.01 | $943.00 | $25.00 – $1,949.62 | 36 |
| Ductogram sgl duct CPT 77053 | $4.69 | $67.00 | $17.01 – $745.26 | 37 |
| Duodenal exclusion CPT 48547 | $415.45 | $5,935.00 | $75.00 – $3,065.57 | 34 |
| Duplex scan bilateral study 93985 CPT 93985 | $336.35 | $4,805.00 | $36.33 – $1,654.21 | 37 |
| Dup scan/hemodialysis access 93990 CPT 93990 | $183.33 | $2,619.00 | $19.84 – $1,016.22 | 37 |
| Dup scan/lwr xtr vasc stdy bilat 93924 CPT 93924 | $32.20 | $460.00 | $23.58 – $857.18 | 37 |
| Dup scan/ue art/graft/bilat/comp 93930 CPT 93930 | $357.28 | $5,104.00 | $37.27 – $1,410.30 | 37 |
| Dx bronchoscope/brush 31623 CPT 31623 | $31.01 | $443.00 | $15.00 – $537.16 | 34 |
| Dx bronchoscope/lavage 31624 CPT 31624 | $31.50 | $450.00 | $15.00 – $507.90 | 34 |
| Dx bronchoscope/wash 31622 CPT 31622 | $30.94 | $442.00 | $15.00 – $506.48 | 34 |
| Dx laryngoscopy w/oper scope CPT 31526 | $37.73 | $539.00 | $134.72 – $354.22 | 34 |
| Ear and throat examination CPT 92502 | $16.73 | $239.00 | $61.76 – $178.53 | 34 |
| Ear canal biopsy 69105 CPT 69105 | $35.84 | $512.00 | $10.00 – $304.00 | 36 |
| Ear cartilage graft CPT 21235 | $140.98 | $2,014.00 | $75.00 – $1,338.32 | 34 |
| Ear irrigation 69209 CPT 69209 | $13.37 | $191.00 | $11.00 – $155.62 | 36 |
| Ecg 12 lead tracing only CPT 93005 | $74.83 | $1,069.00 | $7.43 – $155.62 | 36 |
| Ecg/1-3 leads/interp & report only 93042 CPT 93042 | $3.43 | $49.00 | $7.10 – $17.27 | 34 |
| Ecg/1-3 leads/tracing only 93041 CPT 93041 | $47.53 | $679.00 | $7.06 – $155.62 | 36 |
| Ecg < 30 days transmission & analysis CPT 93271 | $60.20 | $860.00 | $79.80 – $1,773.13 | 36 |
| Ecg external < 48 hours recording CPT 93225 | $87.36 | $1,248.00 | $19.58 – $422.53 | 36 |
| Ecg external < 48 hours scanning analysis w/report CPT 93226 | $125.65 | $1,795.00 | $37.88 – $745.26 | 36 |
| Ecg external > 48 hours up to 7 days recording CPT 93242 | $2.80 | $40.00 | $12.63 – $159.60 | 37 |
| Ecg external >7 days up to 15 days recording CPT 93246 | $4.27 | $61.00 | $12.63 – $159.60 | 37 |
| Ecg record/review CPT 93268 | $47.74 | $682.00 | $87.15 – $2,472.68 | 37 |
| Ecg/review interpret only CPT 93272 | $4.55 | $65.00 | $21.75 – $279.82 | 37 |
| Echocardiogram (Heart Ultrasound) CPT 93306 | $525.56 | $7,508.00 | $69.26 – $2,204.52 | 37 |
| Echocardiography doppler color flow mapping CPT 93325 | $117.67 | $1,681.00 | $3.48 – $872.57 | 37 |
| Echocardiography transthoracic 2d complete w/contrast or without & w/contrast with doppler HCPCS C8929 | $18.76 | $268.00 | $268.00 – $3,256.82 | 25 |
| Echocardiography transthoracic 2d followup/limited CPT 93308 | $128.52 | $1,836.00 | $25.34 – $672.04 | 37 |
| Echocardiography transthoracic 2d followup/limited w/contrast or without & w/contrast HCPCS C8924 | $6.93 | $99.00 | $74.00 – $920.30 | 21 |
| Echocardiograpy doppler follow up/limited study CPT 93321 | $1.96 | $28.00 | $7.47 – $332.99 | 37 |
| Echo exam of eye CPT 76519 | $8.47 | $121.00 | $31.36 – $355.24 | 37 |
| Echo exam of eye thickness CPT 76514 | $3.15 | $45.00 | $6.07 – $76.30 | 37 |
| Echo exam of fetal heart CPT 76827 | $78.89 | $1,127.00 | $28.14 – $275.78 | 37 |
| Echo exam uterus 76831- CPT 76831 | $9.52 | $136.00 | $35.48 – $629.41 | 37 |
| Echograp trans r pros study CPT 76873 | $21.14 | $302.00 | $78.36 – $592.49 | 37 |
| Echo guide for amniocentesis CPT 76946 | $5.04 | $72.00 | $18.78 – $34.40 | 34 |
| Echo guide for artery repair CPT 76936 | $73.85 | $1,055.00 | $92.72 – $1,017.22 | 37 |
| Echo stress CPT 93350 | $272.37 | $3,891.00 | $69.26 – $1,441.40 | 37 |
| Echo tee probe placement image acquisition interpretation & report CPT 93312 | $531.37 | $7,591.00 | $108.09 – $1,441.40 | 37 |
| Echo transesophageal CPT 93313 | $7.35 | $105.00 | $10.31 – $126.00 | 34 |
| Echo transesophageal CPT 93314 | $63.77 | $911.00 | $89.45 – $1,130.48 | 37 |
| Echo transesophageal CPT 93315 | $35.14 | $502.00 | $127.04 – $872.57 | 34 |
| Echo transthoracic CPT 93303 | $62.58 | $894.00 | $61.79 – $1,441.40 | 37 |
| Echo transthoracic CPT 93304 | $222.46 | $3,178.00 | $35.77 – $1,441.40 | 37 |
| Echo tte 2d comp wo ctrst wo clr/dplr CPT 93307 | $262.01 | $3,743.00 | $44.29 – $1,331.48 | 37 |
| Ecmo/ecls initiation venous 33946 CPT 33946 | $69.72 | $996.00 | $40.00 – $910.54 | 34 |
| Ecmo/ecls remove prph cannula 6yrs&older perq 33966 CPT 33966 | $53.13 | $759.00 | $55.00 – $690.92 | 34 |
| Edu/train/pt/nonmd/in person/30 min98960 CPT 98960 | $7.49 | $107.00 | $30.40 – $128.40 | 15 |
| Eeg/cerebral death evaluation only 95824 -26 CPT 95824 | $195.02 | $2,786.00 | $39.64 – $3,840.54 | 37 |
| Eeg monitor/record/awake/drowsy 95816 CPT 95816 | $173.46 | $2,478.00 | $58.16 – $593.22 | 37 |
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.