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 |
|---|---|---|---|---|
| Intens cardiac rehab w/exerc HCPCS G0422 | $59.15 | $845.00 | $103.00 – $513.53 | 23 |
| Interdiscal perq aspir dx CPT 62267 | $36.54 | $522.00 | $8.00 – $670.18 | 34 |
| Intermediate visual field xm CPT 92082 | $8.40 | $120.00 | $21.11 – $155.62 | 36 |
| Internal nerve revision 64727 CPT 64727 | $42.98 | $614.00 | $35.37 – $471.99 | 34 |
| Interrogate subq defib CPT 93261 | $6.09 | $87.00 | $33.77 – $268.16 | 37 |
| Interrogation vad in person CPT 93750 | $7.42 | $106.00 | $34.05 – $118.59 | 34 |
| Interrog dev eval icpms ip CPT 93290 | $9.38 | $134.00 | $14.94 – $98.45 | 37 |
| Interrog dev eval scrms ip CPT 93291 | $8.68 | $124.00 | $17.90 – $135.71 | 37 |
| Interrog device eval heart CPT 93289 | $29.12 | $416.00 | $32.87 – $183.28 | 37 |
| Interrog evl pm/ldls pm ip CPT 93288 | $18.90 | $270.00 | $20.67 – $151.57 | 37 |
| Intestinal stricturoplasty CPT 44615 | $250.25 | $3,575.00 | $60.00 – $1,863.53 | 34 |
| Int hrhc lig 1 hroid without img CPT 46945 | $85.12 | $1,216.00 | $40.00 – $7,321.98 | 36 |
| Int hrhc lig 2+hroid without img CPT 46946 | $94.43 | $1,349.00 | $35.00 – $7,321.98 | 36 |
| Intra-atrial pacing CPT 93610 | $26.04 | $372.00 | $87.00 – $310.78 | 34 |
| Intranasal biopsy 30100 CPT 30100 | $34.93 | $499.00 | $36.11 – $304.00 | 36 |
| Intraop colon lavage add-on CPT 44701 | $38.57 | $551.00 | $122.49 – $310.59 | 34 |
| Intraoral i+d tongue/floor lingual 41000 CPT 41000 | $26.60 | $380.00 | $45.00 – $231.09 | 34 |
| Intraoral periapical first HCPCS D0220 | $3.85 | $55.00 | $55.00 – $304.00 | 17 |
| Intrinsic factor antibody CPT 86340 | $1.06 | $15.08 | $5.56 – $165.75 | 23 |
| Intrm oph exam est patient CPT 92012 | $15.82 | $226.00 | $22.59 – $304.00 | 36 |
| Intro cath dialysis circuit CPT 36901 | $635.18 | $9,074.00 | $45.00 – $4,152.50 | 36 |
| Intro cath dialysis circuit w/pta CPT 36902 | $2,232.44 | $31,892.00 | $50.00 – $15,013.92 | 36 |
| Intro cath dialysis circuit w/stent plcmnt CPT 36903 | $3,206.63 | $45,809.00 | $268.50 – $30,452.80 | 36 |
| Intro catheter aorta CPT 36200 | $395.50 | $5,650.00 | $40.00 – $1,235.41 | 36 |
| Intro cath svc/ivc CPT 36010 | $527.31 | $7,533.00 | $15.00 – $1,290.32 | 36 |
| Intro long gi tube CPT 44500 | $125.93 | $1,799.00 | $16.19 – $2,392.56 | 36 |
| Intro long gi tube w/mult fluo CPT 74340 | $7.00 | $100.00 | $25.50 – $120.00 | 34 |
| Intrvasc Ultrasound noncoronary 1st vessel CPT 37252 | $451.50 | $6,450.00 | $75.19 – $4,790.65 | 36 |
| Intrvasc Ultrasound noncoronary addl vessel CPT 37253 | $15.96 | $228.00 | $45.00 – $704.64 | 34 |
| Intubation endotracheal emergency procedure CPT 31500 | $104.23 | $1,489.00 | $25.00 – $304.00 | 36 |
| Iopamidol 250 mg iodine/ml (51 %) intravenous solution HCPCS Q9966 | $0.59 | $8.48 | $0.22 – $9.09 | 10 |
| Iopamidol 300 mg iodine/ml (61 %) intravenous solution HCPCS Q9967 | $1.12 | $16.00 | $0.22 – $10.60 | 10 |
| Ip/obs cnsltj new/est low 45 CPT 99253 | $23.87 | $341.00 | $130.49 – $304.00 | 27 |
| Ip/obs cnsltj new/est mod 60 CPT 99254 | $30.59 | $437.00 | $152.00 – $406.80 | 27 |
| Ip/obs consltj new/est hi 80 CPT 99255 | $40.25 | $575.00 | $152.00 – $552.00 | 27 |
| Ip/obs consltj new/est sf 35 CPT 99252 | $15.12 | $216.00 | $84.80 – $304.00 | 27 |
| Ipratropium bromide non-comp HCPCS J7644 | $2.10 | $30.00 | $0.39 – $7.20 | 19 |
| Iron CPT 83540 | $45.01 | $643.00 | $2.07 – $71.21 | 23 |
| Iron binding capacity CPT 83550 | $0.61 | $8.74 | $2.42 – $75.21 | 23 |
| Iron dextran 50 mg/ml injection solution HCPCS J1750 | $3.15 | $45.00 | $8.78 – $52.20 | 31 |
| Iron sucrose 20 mg iron/ml intravenous solution (wrapper) HCPCS J1756 | $164.74 | $2,353.43 | $0.32 – $1,730.56 | 11 |
| Irradiation of blood product each unit reference CPT 86945 | $4.55 | $65.00 | $9.94 – $197.87 | 23 |
| Irrigation implantable venous access device for drug delivery systems CPT 96523 | $42.98 | $614.00 | $14.72 – $155.62 | 30 |
| Irrigation vagina and/or appl medicament tx disease CPT 57150 | $5.95 | $85.00 | $6.00 – $155.62 | 36 |
| Island pedicle flap graft CPT 15740 | $205.80 | $2,940.00 | $505.96 – $1,397.12 | 34 |
| Ivc venogram s&i CPT 75825 | $631.82 | $9,026.00 | $51.75 – $8,329.20 | 37 |
| IV infusion therapy/prophylaxis/diagnosis addl sequential infusion new drug/substance > 1 hour CPT 96367 | $53.69 | $767.00 | $31.05 – $189.93 | 36 |
| IV infusion therapy/prophylaxis/diagnosis concurrent infusion CPT 96368 | $49.77 | $711.00 | $17.96 – $47.24 | 36 |
| IV infusion therapy/prophylaxis/diagnosis each additional 1 hour CPT 96366 | $60.97 | $871.00 | $19.27 – $123.52 | 36 |
| IV infusion therapy/prophylaxis/diagnosis initial up to 1 hour CPT 96365 | $106.40 | $1,520.00 | $62.60 – $561.09 | 36 |
| Ivp w/nephrotomography CPT 74415 | $303.17 | $4,331.00 | $23.07 – $596.62 | 37 |
| Ivp w/wo kub w/wo tomography CPT 74400 | $145.18 | $2,074.00 | $23.07 – $476.30 | 37 |
| Jak2 targeted sequence analysis CPT 81279 | $20.65 | $295.00 | $65.08 – $690.97 | 23 |
| Jejunstmy tube plcmt CPT 44372 | $56.35 | $805.00 | $35.00 – $643.86 | 34 |
| John cunningham antibody CPT 86711 | $2.10 | $30.00 | $3.72 – $120.00 | 23 |
| J-tube placement CPT 44015 | $32.06 | $458.00 | $120.42 – $263.17 | 30 |
| Ketamine and metabolite screen - quest CPT 80357 | $7.42 | $106.00 | $0.03 – $140.58 | 8 |
| Ketone body(s) beta-hydroxybutyrate quantitative CPT 82010 | $14.42 | $206.00 | $2.92 – $89.35 | 23 |
| Ketorolac 15 mg/ml injection (wrapper) HCPCS J1885 | $13.57 | $193.91 | $0.30 – $32.48 | 31 |
| Kidney endoscopy & treatment CPT 50561 | $92.61 | $1,323.00 | $20.00 – $14,144.02 | 36 |
| Kidney imaging morphology CPT 78700 | $247.45 | $3,535.00 | $20.43 – $1,054.57 | 37 |
| Kidney imag w/bld flow multi CPT 78709 | $473.76 | $6,768.00 | $64.26 – $1,432.31 | 37 |
| Kidney img w/bldflw sgl without rx CPT 78707 | $395.57 | $5,651.00 | $44.17 – $1,432.31 | 37 |
| Kidney (Retroperitoneal) Ultrasound (complete) CPT 76770 | $283.15 | $4,045.00 | $34.69 – $559.51 | 37 |
| Kit cast tcc 3in w/2reg boots total contact cast HCPCS Q4038 | $9.94 | $142.00 | $21.81 – $154.80 | 34 |
| Kit cath ivl 2.5x40mm 135cm shockwave s4 HCPCS C1761 | $1,974.00 | $28,200.00 | $28,200.00 – $35,250.00 | 4 |
| Kit gene analys d816 variant CPT 81273 | $19.60 | $280.00 | $124.87 – $1,025.13 | 24 |
| Kit lead specify 5-6-5 HCPCS C1778 | $2,972.06 | $42,458.00 | $22,608.00 – $28,260.00 | 4 |
| Kit montgmry thyrplasty impl f 5 implants 1meas dev inst set HCPCS C1878 | $662.83 | $9,469.00 | $74.00 – $10,719.60 | 9 |
| Knee Arthroscopy (Cartilage Repair) CPT 29877 | $152.95 | $2,185.00 | $65.00 – $1,205.43 | 34 |
| Knee arthroscopy/drainage CPT 29871 | $127.54 | $1,822.00 | $65.00 – $1,010.86 | 34 |
| Knee arthroscopy dx CPT 29870 | $103.04 | $1,472.00 | $278.48 – $941.71 | 34 |
| Knee Arthroscopy (Meniscus Repair) CPT 29881 | $374.57 | $5,351.00 | $70.00 – $8,631.30 | 36 |
| Knee arthroscopy/surgery CPT 29850 | $154.14 | $2,202.00 | $96.43 – $1,096.28 | 34 |
| Knee arthroscopy/surgery CPT 29851 | $226.24 | $3,232.00 | $50.00 – $1,872.22 | 34 |
| Knee arthroscopy/surgery CPT 29873 | $134.33 | $1,919.00 | $90.00 – $1,015.60 | 34 |
| Knee arthroscopy/surgery CPT 29874 | $132.09 | $1,887.00 | $188.00 – $1,060.69 | 34 |
| Knee arthroscopy/surgery CPT 29875 | $122.85 | $1,755.00 | $239.00 – $984.75 | 34 |
| Knee arthroscopy/surgery CPT 29876 | $160.44 | $2,292.00 | $521.22 – $1,274.25 | 34 |
| Knee arthroscopy/surgery CPT 29879 | $162.61 | $2,323.00 | $95.00 – $1,290.86 | 34 |
| Knee arthroscopy/surgery CPT 29880 | $138.67 | $1,981.00 | $196.00 – $1,350.18 | 34 |
| Knee arthroscopy/surgery CPT 29882 | $168.70 | $2,410.00 | $90.00 – $1,357.30 | 34 |
| Knee arthroscopy/surgery CPT 29883 | $204.82 | $2,926.00 | $60.00 – $1,677.64 | 34 |
| Knee arthroscopy/surgery CPT 29884 | $152.67 | $2,181.00 | $90.00 – $1,200.69 | 34 |
| Knee arthroscopy/surgery CPT 29886 | $157.08 | $2,244.00 | $90.00 – $1,229.16 | 34 |
| Knee arthroscopy/surgery CPT 29887 | $185.15 | $2,645.00 | $60.00 – $1,452.21 | 34 |
| Knee arthroscopy/surgery CPT 29888 | $235.90 | $3,370.00 | $334.00 – $1,983.74 | 34 |
| Knee arthroscopy/surgery CPT 29889 | $297.57 | $4,251.00 | $674.61 – $2,408.49 | 34 |
| Knee control full kneecap HCPCS L2795 | $22.33 | $319.00 | $47.76 – $370.04 | 32 |
| Knee disc/dial lock/adj flex HCPCS L2425 | $29.47 | $421.00 | $70.12 – $488.36 | 32 |
| Knee MRI (with and without contrast) CPT 73723 | $712.67 | $10,181.00 | $56.31 – $7,072.14 | 37 |
| Knee MRI (with contrast) CPT 73722 | $673.68 | $9,624.00 | $42.56 – $3,820.49 | 37 |
| Knee MRI (without contrast) CPT 73721 | $630.21 | $9,003.00 | $35.56 – $3,122.73 | 37 |
| Knee X-ray CPT 73564 | $184.80 | $2,640.00 | $11.34 – $275.78 | 37 |
| Kyleena, 19.5 mg HCPCS J7296 | $184.31 | $2,633.00 | $1,214.63 – $3,159.60 | 18 |
| Labetalol 5 mg/ml IV (wrapper) HCPCS J1920 | $14.85 | $212.18 | $0.15 – $107.28 | 10 |
| Labioplasty 56800 CPT 56800 | $61.18 | $874.00 | $55.00 – $507.80 | 34 |
| Lacosamide 200 mg/20 ml intravenous solution HCPCS C9254 | $73.92 | $1,056.00 | $0.10 – $1,509.02 | 8 |
| Lactate dehydrogenase (ldh) CPT 83615 | $40.95 | $585.00 | $2.09 – $66.18 | 23 |
| Lactated ringers intravenous solution HCPCS J7120 | $14.49 | $207.01 | $3.37 – $238.25 | 11 |
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.