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 |
|---|---|---|---|---|
| Ghs ot prosthetic training/15 min CPT 97761 | $22.61 | $323.00 | $42.79 – $499.00 | 23 |
| Ghs ot sensory integrative tech/15min CPT 97533 | $32.90 | $470.00 | $33.28 – $499.00 | 25 |
| Ghs pacing - transcutaneous CPT 92953 | $116.13 | $1,659.00 | $0.88 – $1,743.52 | 36 |
| Ghs paravert facet/nerve cerv ea add bil CPT 64492 | $21.42 | $306.00 | $12.00 – $189.07 | 36 |
| Ghs paravert facet/nerve lumb ea add bil CPT 64495 | $364.42 | $5,206.00 | $7.00 – $172.45 | 36 |
| Ghs path - pap (papanicolau) smear - vagina CPT 88141 | $1.66 | $23.70 | $15.10 – $203.65 | 24 |
| Ghs peritonsillar abscess i andd CPT 42700 | $47.88 | $684.00 | $17.00 – $304.00 | 36 |
| Ghs picc line insert < 5 CPT 36568 | $21.35 | $305.00 | $68.50 – $4,152.50 | 36 |
| Ghs plngl fx pm cl CPT 26725 | $88.62 | $1,266.00 | $135.52 – $643.06 | 36 |
| Ghs plt ct-manual CPT 85032 | $0.30 | $4.31 | $1.06 – $47.38 | 23 |
| Ghs polysom <6 yrs 4/> parameters CPT 95782 | $178.15 | $2,545.00 | $124.69 – $7,686.21 | 37 |
| Ghs pos nystagmus CPT 92542 | $5.46 | $78.00 | $13.93 – $43.43 | 34 |
| Ghs ppd (tb intradermal) CPT 86580 | $7.42 | $106.00 | $3.36 – $76.30 | 36 |
| Ghs prostatic acid phosphatase (mayo) CPT 84066 | $0.68 | $9.66 | $3.35 – $106.38 | 23 |
| Ghs protein, misc fluid CPT 84160 | $0.39 | $5.61 | $1.46 – $56.85 | 23 |
| Ghs protoporphyrins fract CPT 84202 | $1.00 | $14.35 | $5.29 – $157.83 | 23 |
| Ghs pr without cont pulse ox CPT 94625 | $37.03 | $529.00 | $16.05 – $155.62 | 35 |
| Ghs pseudocholinesterase,dibucain-inhibi CPT 82638 | $0.76 | $10.89 | $4.49 – $134.66 | 23 |
| Ghs refill of implantable pump CPT 95990 | $16.03 | $229.00 | $49.52 – $155.45 | 34 |
| Ghs removal intranasal foreign body CPT 30300 | $52.36 | $748.00 | $56.22 – $360.32 | 36 |
| Ghs removal pharyngeal foreign body CPT 42809 | $50.96 | $728.00 | $35.00 – $304.00 | 36 |
| Ghs repair extensor tendon hand, ea tendon CPT 26410 | $184.73 | $2,639.00 | $428.28 – $4,241.76 | 35 |
| Ghs repair tendon ext forearm/wrist ea CPT 25270 | $123.97 | $1,771.00 | $75.00 – $1,357.30 | 34 |
| Ghs reticulocyte count CPT 85044 | $0.30 | $4.31 | $1.46 – $47.30 | 23 |
| Ghs rsv eia (respir synctial vrs) CPT 87420 | $0.97 | $13.91 | $3.18 – $98.83 | 23 |
| Ghs sedimentation rate CPT 85651 | $0.30 | $4.27 | $1.18 – $39.01 | 23 |
| Ghs semen analysis fert CPT 89320 | $61.81 | $883.00 | $12.31 – $164.71 | 23 |
| Ghs semen analysis, post-vas CPT 89300 | $2.73 | $39.00 | $3.84 – $46.80 | 33 |
| Ghs sensitivity (per antimicro) CPT 87184 | $4.76 | $68.00 | $2.45 – $75.73 | 23 |
| Ghs simple repair 12.6 - 20.0 cm - 12005 CPT 12005 | $43.12 | $616.00 | $35.00 – $354.70 | 36 |
| Ghs simple repair 12.6 - 20.0 cm - 12016 CPT 12016 | $53.41 | $763.00 | $115.69 – $465.71 | 36 |
| Ghs simple repair 20.1 - 30.0 cm - 12006 CPT 12006 | $49.84 | $712.00 | $104.02 – $441.34 | 36 |
| Ghs simple repair 20.1 - 30.0 cm - 12017 CPT 12017 | $35.00 | $500.00 | $65.15 – $1,072.36 | 36 |
| Ghs simple repair 5.1 - 7.5 cm - 12014 CPT 12014 | $34.65 | $495.00 | $68.30 – $314.08 | 36 |
| Ghs simple repair 7.6 - 12.5 cm - 12004 CPT 12004 | $32.48 | $464.00 | $69.21 – $304.00 | 36 |
| Ghs simple repair 7.6 - 12.5 cm - 12015 CPT 12015 | $42.00 | $600.00 | $23.00 – $392.60 | 36 |
| Ghs simple repair over 30 cm - 12007 CPT 12007 | $55.30 | $790.00 | $35.00 – $498.20 | 36 |
| Ghs simple repair over 30 cm - 12018 CPT 12018 | $39.62 | $566.00 | $41.00 – $529.26 | 36 |
| Ghs sleep study unattended CPT 95800 | $103.74 | $1,482.00 | $34.15 – $1,243.80 | 37 |
| Ghs sphenopalatine ganglion block CPT 64505 | $53.27 | $761.00 | $60.68 – $304.00 | 36 |
| Ghs spont nystagmus CPT 92541 | $5.46 | $78.00 | $14.57 – $40.65 | 34 |
| Ghs st - eval for alt comm CPT 92567 | $5.46 | $78.00 | $8.80 – $98.53 | 36 |
| Ghs strapping shoulder - 29240 CPT 29240 | $7.35 | $105.00 | $15.65 – $304.00 | 36 |
| Ghs st - re-eval for alt comm CPT 92597 | $47.67 | $681.00 | $74.35 – $499.00 | 24 |
| Ghs superficial wnd dehiscence simp12020 CPT 12020 | $74.27 | $1,061.00 | $152.00 – $406.14 | 36 |
| Ghs superficial wnd dehis w packing12021 CPT 12021 | $43.47 | $621.00 | $20.00 – $304.00 | 36 |
| Ghs tracheostomy emergency - transtracheal CPT 31603 | $74.20 | $1,060.00 | $106.48 – $4,092.96 | 36 |
| Ghs tx distal phalangeal fx with manipulation CPT 26755 | $83.65 | $1,195.00 | $128.07 – $590.85 | 36 |
| Ghs urine, porphyrins quant CPT 84120 | $1.03 | $14.71 | $5.03 – $161.75 | 23 |
| Ghs vaginal delivery only CPT 59409 | $182.49 | $2,607.00 | $40.00 – $8,539.30 | 36 |
| Ghs windowing of cast CPT 29730 | $16.10 | $230.00 | $2.00 – $304.00 | 36 |
| Giardia ag if CPT 87269 | $0.95 | $13.61 | $2.78 – $102.53 | 23 |
| Giardia lamblia antibody CPT 86674 | $4.41 | $63.00 | $5.36 – $159.90 | 23 |
| Gi inhouse confirmation CPT 87045 | $63.35 | $905.00 | $3.42 – $103.71 | 23 |
| Gi tract capsule endoscopy (pillcam) 91110 CPT 91110 | $128.03 | $1,829.00 | $121.98 – $7,111.18 | 37 |
| Gjb6 gene com variants CPT 81254 | $2.45 | $35.00 | $35.00 – $79.65 | 22 |
| Glucagon 1 mg solution for injection HCPCS J1610 | $31.57 | $451.00 | $135.47 – $523.16 | 18 |
| Glucagon hcl 1 mg/ml solution for injection HCPCS J1611 | $312.70 | $4,467.12 | $93.04 – $389.99 | 22 |
| Glucagon plasma - sendout CPT 82943 | $1.00 | $14.29 | $5.26 – $133.40 | 23 |
| Glucose 1 hr post dose CPT 82950 | $51.87 | $741.00 | $1.39 – $52.19 | 23 |
| Glucose blood by monitoring device cleared by fda for home use CPT 82962 | $7.98 | $114.00 | $0.43 – $6.56 | 35 |
| Glucose blood quantitative CPT 82947 | $40.81 | $583.00 | $0.63 – $38.91 | 36 |
| Glucose body fluid CPT 82945 | $40.74 | $582.00 | $0.91 – $43.08 | 23 |
| Glucose monitoring continual min 72hr pt CPT 95249 | $12.11 | $173.00 | $152.00 – $487.62 | 19 |
| Glucose tolerance test (gtt) 3 specimens CPT 82951 | $29.75 | $425.00 | $4.24 – $141.54 | 23 |
| Glucose tolerance test (gtt) >3 specimens each additional CPT 82952 | $9.73 | $139.00 | $1.14 – $43.16 | 23 |
| Glycopyrrolate 0.2 mg/ml injection solution HCPCS J1596 | $11.09 | $158.46 | $0.76 – $201.66 | 10 |
| Gonadotropin follicle stimulating hormone (fsh) CPT 83001 | $52.36 | $748.00 | $6.90 – $204.31 | 23 |
| Gonadotropin luteinizing hormone (lh) CPT 83002 | $70.42 | $1,006.00 | $6.87 – $203.65 | 23 |
| Gonioscopy CPT 92020 | $4.83 | $69.00 | $16.80 – $350.97 | 36 |
| Goniotomy CPT 65820 | $202.02 | $2,886.00 | $421.82 – $1,361.74 | 34 |
| Goserelin 10.8 mg subcutaneous implant HCPCS J9202 | $119.14 | $1,702.00 | $683.27 – $2,042.40 | 18 |
| Graft apligraf 3in 44sqcm-q4101-cost per sq cm HCPCS Q4101 | $16.31 | $233.00 | $19.23 – $278.94 | 36 |
| Graft axiofill 1000mg HCPCS J3590 | $61.29 | $875.60 | $875.60 – $1,251.24 | 5 |
| Graft fish skin 16mm round marigen 2units-cost per sq cm HCPCS Q4158 | $90.93 | $1,299.00 | $75.46 – $346.14 | 22 |
| Graft hand or finger tendon CPT 26416 | $226.94 | $3,242.00 | $111.32 – $1,760.69 | 34 |
| Graft nerve adv 3-4x70mm HCPCS C1762 | $3,850.00 | $55,000.00 | $74.00 – $1,820.59 | 9 |
| Graft patch felt ptfe 2x2 HCPCS C1768 | $900.48 | $12,864.00 | $797.00 – $996.25 | 4 |
| Graft puraplyam antimicrob 1.6-q4196-cost per sq cm HCPCS Q4196 | $148.47 | $2,121.00 | $101.03 – $306.24 | 33 |
| Graft repair of spine defect 63710 CPT 63710 | $258.58 | $3,694.00 | $35.00 – $2,612.92 | 34 |
| Graft sft tiss grafix amnio prime 3x4cm 12sqcm-q4133-cost per sq cm HCPCS Q4133 | $241.99 | $3,457.00 | $82.31 – $402.52 | 34 |
| Graft wnd mtrx grfx core 1.5x2cm-q4132-cost per sq cm HCPCS Q4132 | $23.94 | $342.00 | $106.70 – $396.72 | 31 |
| Graft xenmtrx sft rect 15x20cm HCPCS C1781 | $4,425.19 | $63,217.00 | $74.00 – $898.66 | 9 |
| Graft xenmtrx sft rect 19x28cm HCPCS C2625 | $446.25 | $6,375.00 | $74.00 – $737.19 | 9 |
| Great toe with reduction 28495 CPT 28495 | $47.04 | $672.00 | $10.00 – $304.00 | 36 |
| Grfg autol soft tiss dir exc CPT 15769 | $116.97 | $1,671.00 | $424.05 – $9,348.08 | 36 |
| Group health education CPT 99078 | $1.47 | $21.00 | $21.00 – $75.57 | 11 |
| Gstrct prtl dstl w/roux-en-y rcnstj 43633 CPT 43633 | $446.46 | $6,378.00 | $35.00 – $3,415.20 | 36 |
| Gstrst open wo constj tube CPT 43830 | $166.46 | $2,378.00 | $40.00 – $5,061.94 | 36 |
| G-tube reposition CPT 43761 | $397.39 | $5,677.00 | $79.30 – $659.08 | 36 |
| Gu dilat ureter/urethra s&i CPT 74485 | $382.69 | $5,467.00 | $29.98 – $5,514.28 | 37 |
| Guided cath fluid drainage 10030 CPT 10030 | $608.86 | $8,698.00 | $115.97 – $1,957.59 | 36 |
| Guide endoanchr sg-64 aaa 62cm HCPCS L8670 | $462.42 | $6,606.00 | $681.49 – $5,046.25 | 16 |
| Guide wire threaded 1.4x150mm HCPCS C1769 | $883.75 | $12,625.00 | $74.00 – $119.46 | 9 |
| Guide worley csg 9fx50cm std HCPCS C1892 | $66.29 | $947.00 | $451.00 – $644.48 | 5 |
| Guid loc target vol rad tx CPT 77387 | $480.48 | $6,864.00 | $17.24 – $497.66 | 31 |
| Gw stiffened micro access kit HCPCS C1894 | $220.50 | $3,150.00 | $288.00 – $411.55 | 5 |
| Gynecomastia (males) 19300 CPT 19300 | $105.98 | $1,514.00 | $75.00 – $745.79 | 34 |
| Haloperidol lactate 5 mg/ml injection solution HCPCS J1630 | $11.09 | $158.46 | $0.01 – $226.43 | 11 |
| Handle/convey/speciman/office-lab 99000 CPT 99000 | $9.94 | $142.00 | $2.63 – $24.00 | 15 |
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.