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 |
|---|---|---|---|---|
| Lead ingevity 45cm pfret MRI HCPCS C1898 | $883.75 | $12,625.00 | $2,250.00 – $2,812.50 | 4 |
| Lead tachy durata sj4 58cm HCPCS C1777 | $2,651.18 | $37,874.00 | $25,250.00 – $31,562.50 | 4 |
| Lefort i-1 piece without graft CPT 21141 | $326.34 | $4,662.00 | $75.00 – $2,622.05 | 34 |
| Left compres band >=3" <5"/yd HCPCS A6449 | $0.54 | $7.74 | $0.80 – $7.20 | 34 |
| Left compres band <3"/yd HCPCS A6448 | $0.37 | $5.30 | $0.53 – $4.80 | 34 |
| Left compres band >=5"/yd HCPCS A6450 | $0.56 | $8.00 | $1.04 – $15.11 | 32 |
| Leg Vein Ultrasound (DVT study, both legs) CPT 93970 | $267.19 | $3,817.00 | $32.23 – $1,260.59 | 37 |
| Leishmania antibody CPT 86717 | $0.76 | $10.89 | $4.49 – $134.88 | 23 |
| Lengthening or shortening - tibia and fibula 27715 CPT 27715 | $259.63 | $3,709.00 | $90.00 – $2,126.12 | 34 |
| Lengthen metacarpal/finger CPT 26568 | $229.46 | $3,278.00 | $168.65 – $19,141.34 | 36 |
| Lens iol 23.0 d 1.5 cyl eyhance toric HCPCS V2787 | $65.59 | $937.00 | $7.15 – $394.98 | 11 |
| Lens iol ant bicnvx 24.0 multi HCPCS V2632 | $662.83 | $9,469.00 | $60.58 – $360.28 | 28 |
| Leuprolide 30 mg (4 month) intramuscular syringe kit HCPCS J9217 | $53.06 | $758.00 | $175.24 – $879.28 | 18 |
| Leuprolide 3.75 mg intramuscular syringe kit HCPCS J1950 | $205.17 | $2,931.00 | $1,730.32 – $3,399.96 | 18 |
| Levalbuterol non-comp unit HCPCS J7614 | $0.28 | $4.00 | $0.08 – $4.80 | 18 |
| Levetiracetam 500 mg/5 ml intravenous solution HCPCS J1953 | $56.97 | $813.91 | $0.08 – $209.47 | 11 |
| Levetiracetam therapeutic drug level CPT 80177 | $8.89 | $127.00 | $11.78 – $83.95 | 23 |
| Levofloxacin 250 mg/50 ml in 5 % dextrose intravenous piggyback HCPCS J1956 | $17.24 | $246.22 | $4.86 – $280.21 | 10 |
| Levothyroxine 100 mcg intravenous powder for solution HCPCS J0650 | $152.66 | $2,180.92 | $5.91 – $3,116.53 | 10 |
| Liberta rc ipg HCPCS C1820 | $6,123.25 | $87,475.00 | $74.00 – $104,970.00 | 9 |
| Lidocaine (pf) 10 mg/ml (1 %) injection solution HCPCS J2003 | $20.27 | $289.60 | $0.01 – $4.40 | 15 |
| Lidocaine (pf) 4 mg/ml (0.4 %) in 5 % dextrose intravenous solution HCPCS J2002 | $0.91 | $13.00 | $0.01 – $15.60 | 14 |
| Lidocaine therapeutic drug level CPT 80176 | $6.93 | $99.00 | $5.23 – $161.45 | 23 |
| Ligate leg veins radical 37760 CPT 37760 | $129.71 | $1,853.00 | $84.51 – $1,125.60 | 34 |
| Ligate oviduct(s) add-on 58611 CPT 58611 | $17.57 | $251.00 | $30.00 – $168.39 | 34 |
| Ligate/strip long leg vein CPT 37722 | $104.09 | $1,487.00 | $45.00 – $8,329.20 | 36 |
| Ligate/strip short leg vein CPT 37718 | $89.25 | $1,275.00 | $75.00 – $722.94 | 34 |
| Ligate/transect fallopian tubes 58600 CPT 58600 | $89.11 | $1,273.00 | $41.00 – $765.65 | 34 |
| Ligation/biopsy of temporal artery 37609 CPT 37609 | $187.04 | $2,672.00 | $21.00 – $507.89 | 36 |
| Ligation/divis of long saph vein 37700 CPT 37700 | $56.84 | $812.00 | $45.00 – $8,329.20 | 36 |
| Ligation external carotid artery 37600 CPT 37600 | $178.64 | $2,552.00 | $40.00 – $1,299.47 | 34 |
| Ligation internal/common carotid artery 37605 CPT 37605 | $164.71 | $2,353.00 | $75.00 – $1,482.49 | 34 |
| Ligation/major artery/extremity 37618 CPT 37618 | $91.77 | $1,311.00 | $15.00 – $725.60 | 36 |
| Ligation major artery neck CPT 37615 | $123.41 | $1,763.00 | $460.18 – $814.46 | 27 |
| Ligation of abdomen artery 37617 CPT 37617 | $303.17 | $4,331.00 | $772.89 – $2,315.25 | 34 |
| Ligation of femoral vein CPT 37650 | $103.81 | $1,483.00 | $104.24 – $910.54 | 34 |
| Ligation vericose vein cluster(s) 1 leg CPT 37785 | $81.76 | $1,168.00 | $40.00 – $619.99 | 36 |
| Lig/band angioaccess av fistula CPT 37607 | $86.03 | $1,229.00 | $272.52 – $8,329.20 | 36 |
| Lig&div&compl strpg saph vn CPT 37735 | $130.97 | $1,871.00 | $70.00 – $1,146.19 | 34 |
| Liletta, 52 mg HCPCS J7297 | $126.77 | $1,811.00 | $931.73 – $2,173.20 | 18 |
| Limb exercise test CPT 95875 | $21.63 | $309.00 | $51.18 – $92.94 | 34 |
| Limited visual field xm CPT 92081 | $6.02 | $86.00 | $16.25 – $49.22 | 34 |
| Linezolid in 5% dextrose in water 600 mg/300 ml intravenous piggyback HCPCS J2020 | $34.09 | $487.03 | $3.61 – $695.97 | 11 |
| Lipase CPT 83690 | $54.60 | $780.00 | $2.45 – $75.66 | 23 |
| Lip exc/transverse wedge/w closure 40510 CPT 40510 | $86.24 | $1,232.00 | $322.46 – $8,745.94 | 36 |
| Lipoprotein blood quant CPT 83704 | $2.39 | $34.19 | $7.73 – $339.34 | 23 |
| Lipoprotein direct measurement hdl CPT 83718 | $39.13 | $559.00 | $2.95 – $89.94 | 23 |
| Lipoprotein direct measurement ldl CPT 83721 | $40.74 | $582.00 | $3.42 – $103.71 | 23 |
| Lithium therapeutic drug level CPT 80178 | $49.49 | $707.00 | $2.34 – $72.62 | 23 |
| Lithotripsy transluminal coronary percutaneous CPT 92972 | $1,139.46 | $16,278.00 | $74.00 – $244.80 | 35 |
| Liver abs/cyst dr opn 1-2 stge CPT 47010 | $284.90 | $4,070.00 | $110.20 – $2,043.72 | 34 |
| Liver Function Test CPT 80076 | $51.87 | $741.00 | $2.93 – $89.87 | 23 |
| Liver imaging CPT 78201 | $5.53 | $79.00 | $20.09 – $236.78 | 34 |
| Liver imag w/vasclr flow CPT 78202 | $6.51 | $93.00 | $23.38 – $257.94 | 34 |
| Liver/spleen imag static only CPT 78215 | $324.10 | $4,630.00 | $23.07 – $1,054.57 | 37 |
| Liver/spleen imag w/vasclr flow CPT 78216 | $7.49 | $107.00 | $26.88 – $148.17 | 34 |
| Lngth/shrt tendon leg/ankle 1 tendon CPT 27685 | $115.57 | $1,651.00 | $61.00 – $1,146.11 | 34 |
| Lorazepam 2 mg/ml injection (wrapper) HCPCS J2060 | $12.01 | $171.53 | $1.28 – $6.24 | 19 |
| Low back disk surgery CPT 63030 | $219.31 | $3,133.00 | $426.00 – $2,307.81 | 34 |
| Lower Back (Lumbar Spine) CT scan (with and without contrast) CPT 72133 | $1,057.42 | $15,106.00 | $33.20 – $2,472.88 | 37 |
| Lower Back (Lumbar Spine) CT scan (with contrast) CPT 72132 | $898.87 | $12,841.00 | $31.90 – $1,984.53 | 37 |
| Lower Back (Lumbar Spine) CT scan (without contrast) CPT 72131 | $712.18 | $10,174.00 | $26.20 – $1,659.94 | 37 |
| Lower Back (Lumbar Spine) MRI (with and without contrast) CPT 72158 | $934.92 | $13,356.00 | $60.15 – $6,172.18 | 37 |
| Lower Back (Lumbar Spine) MRI (with contrast) CPT 72149 | $855.75 | $12,225.00 | $46.88 – $3,760.66 | 37 |
| Lower Back (Lumbar Spine) MRI (without contrast) CPT 72148 | $844.76 | $12,068.00 | $39.02 – $3,474.77 | 37 |
| Lower Back (Lumbar Spine) X-ray CPT 72100 | $151.69 | $2,167.00 | $10.97 – $275.78 | 37 |
| Lsh w/t/o ut 250 g or less CPT 58542 | $197.82 | $2,826.00 | $155.00 – $2,017.92 | 34 |
| Lsh w/t/o uterus above 250 g CPT 58544 | $215.46 | $3,078.00 | $130.00 – $2,221.31 | 34 |
| L/s ratio fetal lung CPT 83661 | $1.54 | $21.99 | $8.37 – $241.62 | 23 |
| Lumbar diskogram s&i CPT 72295 | $10.92 | $156.00 | $41.41 – $5,151.14 | 37 |
| Lumbar Spinal Fusion (single level) CPT 22612 | $373.24 | $5,332.00 | $725.00 – $3,141.72 | 34 |
| Lung function test (mbc/mvv) CPT 94200 | $49.77 | $711.00 | $2.61 – $155.62 | 37 |
| Lung Function Test (Spirometry) CPT 94010 | $49.63 | $709.00 | $8.52 – $569.59 | 37 |
| Lung perfusion imaging CPT 78580 | $380.31 | $5,433.00 | $34.33 – $1,054.57 | 37 |
| Lymphadenect/stage/pelv/paraaortic 38562 CPT 38562 | $170.45 | $2,435.00 | $663.45 – $1,455.74 | 27 |
| Lymphatics/lymph node imaging CPT 78195 | $499.87 | $7,141.00 | $54.36 – $1,432.31 | 37 |
| Lymphocyte transformation mitogen CPT 86353 | $10.99 | $157.00 | $16.74 – $538.99 | 23 |
| Lymph vessel x-ray trunk CPT 75807 | $14.14 | $202.00 | $51.50 – $589.42 | 34 |
| Lysis intranasal synechia 30560 CPT 30560 | $37.66 | $538.00 | $30.00 – $1,422.71 | 36 |
| Lysis of labial adhesions CPT 56441 | $44.87 | $641.00 | $28.00 – $313.10 | 36 |
| Lysis penil circumic lesion CPT 54162 | $48.72 | $696.00 | $185.67 – $5,514.28 | 36 |
| Macroscopic exam arthropod CPT 87168 | $31.36 | $448.00 | $1.05 – $46.93 | 23 |
| Macroscopic exam parasite CPT 87169 | $40.74 | $582.00 | $1.05 – $46.93 | 23 |
| Magnesium CPT 83735 | $61.04 | $872.00 | $2.35 – $73.21 | 23 |
| Magnesium sulfate 2 gram/50 ml (4 %) in water intravenous piggyback HCPCS J3475 | $21.78 | $311.18 | $0.22 – $2.40 | 19 |
| Makena, 10 mg HCPCS J1726 | $18.20 | $260.00 | $19.65 – $312.00 | 17 |
| Male sling procedure CPT 53440 | $180.95 | $2,585.00 | $30.00 – $1,467.82 | 34 |
| Manipulate finger w/anesth CPT 26340 | $93.31 | $1,333.00 | $229.34 – $4,241.76 | 36 |
| Manipulation chest wall demonstration/evaluation subsequent CPT 94668 | $32.20 | $460.00 | $16.78 – $499.00 | 24 |
| Manipulation chest wall initial demonstration/evaluation CPT 94667 | $32.13 | $459.00 | $28.54 – $499.00 | 24 |
| Manipulation of hip joint CPT 27275 | $45.78 | $654.00 | $5.00 – $355.94 | 34 |
| Manipulat palm cord post inj CPT 26341 | $29.61 | $423.00 | $35.00 – $304.00 | 36 |
| Mapping io sentinel lymph node CPT 38900 | $31.57 | $451.00 | $22.34 – $294.80 | 36 |
| Marker biop eviva buckle ss HCPCS A4648 | $13.58 | $194.00 | $28.60 – $232.80 | 11 |
| Marker lymphatic sentimag magtrace 10 vial HCPCS A9697 | $524.93 | $7,499.00 | $1,254.00 – $3,414.02 | 14 |
| Mastectomy partial CPT 19301 | $156.38 | $2,234.00 | $66.64 – $10,328.62 | 36 |
| Mast mod rad CPT 19307 | $279.02 | $3,986.00 | $466.00 – $2,255.67 | 34 |
| Mastoids complete CPT 70130 | $121.59 | $1,737.00 | $16.33 – $275.78 | 37 |
| Mastopexy CPT 19316 | $192.36 | $2,748.00 | $474.31 – $1,594.53 | 34 |
| Mast radical CPT 19305 | $271.04 | $3,872.00 | $40.00 – $2,157.30 | 34 |
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.