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 |
|---|---|---|---|---|
| Nrv grf 1strnd hnd/foot <4cm CPT 64890 | $259.21 | $3,703.00 | $60.00 – $2,652.03 | 34 |
| Nrv grf mltst arm/leg <4 cm CPT 64897 | $302.96 | $4,328.00 | $146.31 – $3,053.62 | 34 |
| Nrv grf mltst arm/leg >4 cm CPT 64898 | $328.09 | $4,687.00 | $60.00 – $3,319.60 | 34 |
| Nrv rpr w/nrv algrft 1st CPT 64912 | $217.49 | $3,107.00 | $25.00 – $2,352.15 | 34 |
| Nrv rpr w/nrv algrft ea addl CPT 64913 | $40.18 | $574.00 | $60.00 – $464.17 | 34 |
| Nsl/sins ndsc med/inf dcmprn CPT 31292 | $237.58 | $3,394.00 | $556.22 – $2,182.46 | 34 |
| Nsl/sins ndsc sphn tiss rmvl CPT 31259 | $111.51 | $1,593.00 | $40.00 – $18,617.04 | 36 |
| Nsl/sins ndsc surg frnt sins CPT 31296 | $410.48 | $5,864.00 | $40.00 – $9,941.06 | 36 |
| Nsl/sins ndsc surg frnt&sphn CPT 31298 | $60.69 | $867.00 | $40.00 – $18,617.04 | 36 |
| Nsl/sins ndsc surg max sins CPT 31295 | $404.18 | $5,774.00 | $133.66 – $5,288.18 | 36 |
| Nsl/sins ndsc surg sphn sins CPT 31297 | $400.75 | $5,725.00 | $70.00 – $9,863.35 | 36 |
| Nsl/sins ndsc total CPT 31253 | $177.17 | $2,531.00 | $413.22 – $1,373.47 | 34 |
| Nsl/sins ndsc tot w/sphendt CPT 31257 | $105.42 | $1,506.00 | $369.20 – $18,617.04 | 36 |
| Nsl/sinus endoscopy surg dcr CPT 31239 | $148.47 | $2,121.00 | $60.00 – $1,419.17 | 34 |
| Nsl/sinus ndsc rf abltj pnn CPT 31242 | $615.09 | $8,787.00 | $74.00 – $4,039.86 | 35 |
| Nsl/sns ndsc lig sphnptn art CPT 31241 | $104.93 | $1,499.00 | $35.00 – $1,222.64 | 34 |
| Ntrprof ph1/ntrnet/ehr 11-20 CPT 99447 | $6.37 | $91.00 | $18.20 – $105.60 | 35 |
| Ntrprof ph1/ntrnet/ehr 21-30 CPT 99448 | $9.45 | $135.00 | $47.89 – $156.00 | 35 |
| Ntrprof ph1/ntrnet/ehr 31/> CPT 99449 | $12.60 | $180.00 | $49.98 – $211.20 | 35 |
| Ntrprof ph1/ntrnet/ehr 5/> CPT 99451 | $6.16 | $88.00 | $30.16 – $60.32 | 36 |
| Ntrprof ph1/ntrnet/ehr 5-10 CPT 99446 | $10.78 | $154.00 | $15.90 – $169.40 | 35 |
| Nuclear rx intra-arterial CPT 79445 | $29.75 | $425.00 | $107.24 – $240.61 | 34 |
| Nuclear rx intracav admin CPT 79200 | $21.63 | $309.00 | $79.25 – $176.33 | 34 |
| Nuclear rx IV admin CPT 79101 | $25.55 | $365.00 | $85.82 – $174.25 | 34 |
| Nuclear Stress Test (Heart) CPT 78452 | $1,076.53 | $15,379.00 | $71.91 – $3,415.18 | 37 |
| Nudt15 gene common variants CPT 81306 | $16.32 | $233.09 | $233.09 – $1,906.64 | 23 |
| Nursing facility discharge management > 30 min 99316 CPT 99316 | $23.17 | $331.00 | $46.60 – $238.16 | 36 |
| Nursing facility discharge management 30 min/less than 99315 CPT 99315 | $14.49 | $207.00 | $38.40 – $149.06 | 36 |
| Observation direct referral from physician office for admission HCPCS G0379 | $57.05 | $815.00 | $785.48 – $1,570.97 | 17 |
| Observation/inpatient hospital care hi severity 99236 CPT 99236 | $36.40 | $520.00 | $124.60 – $378.46 | 36 |
| Observation/inpatient hospital care low severity 99234 CPT 99234 | $17.01 | $243.00 | $74.70 – $230.27 | 36 |
| Observation/inpatient hospital care mod severity 99235 CPT 99235 | $27.86 | $398.00 | $103.50 – $303.42 | 36 |
| Observation per hour HCPCS G0378 | $27.58 | $394.00 | $394.00 – $563.03 | 4 |
| Obstetrical care 59410 CPT 59410 | $248.08 | $3,544.00 | $65.00 – $2,448.97 | 34 |
| Obstetrics panel CPT 80055 | $46.90 | $670.00 | $15.01 – $198.48 | 23 |
| Obtaining screen pap smear HCPCS Q0091 | $8.05 | $115.00 | $12.92 – $296.54 | 35 |
| Ob Ultrasound nuchal meas 1 gest CPT 76813 | $32.62 | $466.00 | $57.71 – $501.55 | 37 |
| Occlude fallopian tube(s) device 58615 CPT 58615 | $60.76 | $868.00 | $103.00 – $542.01 | 34 |
| Ocrelizumab 30 mg/ml intravenous solution HCPCS J2350 | $13,350.57 | $190,722.47 | $30.33 – $161.50 | 23 |
| Octreotide acetate 100 mcg/ml injection (wrapper) HCPCS J2354 | $79.98 | $1,142.61 | $0.61 – $15.60 | 19 |
| Octreotide,microspheres ER 20 mg intramuscular susp, extended release HCPCS J2353 | $32.55 | $465.00 | $203.58 – $539.40 | 18 |
| Ocular instrumnt screen bil CPT 99174 | $3.99 | $57.00 | $7.42 – $68.40 | 15 |
| Ocular instrumnt screen bil CPT 99177 | $1.33 | $19.00 | $19.00 – $304.00 | 17 |
| Office emergency care CPT 99058 | $4.97 | $71.00 | $71.00 – $304.00 | 17 |
| Off/op cnsltj new/est low 30 CPT 99243 | $21.07 | $301.00 | $108.89 – $230.40 | 15 |
| Off/op cnsltj new/est mod 40 CPT 99244 | $30.17 | $431.00 | $174.98 – $344.39 | 15 |
| Off/op consltj new/est hi 55 CPT 99245 | $37.10 | $530.00 | $216.48 – $467.50 | 15 |
| Off/op consltj new/est sf 20 CPT 99242 | $14.42 | $206.00 | $77.82 – $161.03 | 15 |
| Olanzapine 10 mg intramuscular solution HCPCS J2359 | $62.06 | $886.52 | $0.91 – $1,266.84 | 10 |
| Ol dig e/m svc 11-20 min CPT 99422 | $5.11 | $73.00 | $22.46 – $74.40 | 36 |
| Ol dig e/m svc 21+ min CPT 99423 | $8.12 | $116.00 | $35.39 – $116.40 | 36 |
| Ol dig e/m svc 5-10 min CPT 99421 | $2.59 | $37.00 | $11.05 – $37.20 | 36 |
| Omental flap intra-abdom 49905 CPT 49905 | $80.57 | $1,151.00 | $30.00 – $770.15 | 36 |
| Oncology prostate prob score CPT 81539 | $53.90 | $770.00 | $760.00 – $3,868.80 | 22 |
| Onco (ovar) five proteins CPT 81503 | $31.15 | $445.00 | $445.00 – $5,962.95 | 23 |
| Oncoprotein dcp CPT 83951 | $4.51 | $64.41 | $57.26 – $675.79 | 23 |
| Oncoprotein her-2/neu CPT 83950 | $23.75 | $339.25 | $64.41 – $708.36 | 22 |
| Ondansetron hcl (pf) 2 mg/ml injection (wrapper) HCPCS J2405 | $11.06 | $158.00 | $0.10 – $6.96 | 19 |
| Open aortofemor prosth repr CPT 34832 | $418.18 | $5,974.00 | $345.49 – $3,685.65 | 34 |
| Open bx/exc inguinofem nodes CPT 38531 | $106.75 | $1,525.00 | $376.40 – $10,328.62 | 36 |
| Open cor endarterect w cabg/ea ves 33572 CPT 33572 | $46.41 | $663.00 | $70.00 – $423.24 | 34 |
| Open tenotomy tendon flexor foot single or multiple 28230 CPT 28230 | $107.52 | $1,536.00 | $152.00 – $714.20 | 36 |
| Open thrombectomy of av fistula without revision 36831 CPT 36831 | $139.30 | $1,990.00 | $40.00 – $14,678.70 | 36 |
| Open tx nose fx w/skele fixj CPT 21330 | $132.58 | $1,894.00 | $70.74 – $1,160.35 | 34 |
| Open tx nose & septal fx CPT 21335 | $175.77 | $2,511.00 | $70.00 – $8,745.94 | 36 |
| Open wedge bx lung nodule 32097 CPT 32097 | $184.80 | $2,640.00 | $65.00 – $1,764.25 | 34 |
| Ophthalmic biometry CPT 92136 | $8.40 | $120.00 | $31.36 – $380.56 | 37 |
| Opioids & opiate analogs 3/4 CPT 80363 | $0.70 | $10.00 | $0.03 – $216.08 | 8 |
| Opn exc/dstr ntra-abd 5.1-10 CPT 49187 | $392.77 | $5,611.00 | $74.00 – $2,422.95 | 26 |
| Opn exc/dstr ntra-abd 5 cm/< CPT 49186 | $309.82 | $4,426.00 | $74.00 – $2,383.20 | 35 |
| Opn impltj nea sacral nerve CPT 64581 | $156.10 | $2,230.00 | $70.00 – $16,811.48 | 36 |
| Opn tx complx malar fx CPT 21365 | $263.20 | $3,760.00 | $55.00 – $2,156.97 | 34 |
| Opn tx dprsd zygomatic arch CPT 21356 | $99.61 | $1,423.00 | $25.00 – $15,616.06 | 36 |
| Opn tx orbit fx combined CPT 21387 | $186.83 | $2,669.00 | $75.00 – $15,616.06 | 36 |
| Opn tx orbit fx periorbital CPT 21386 | $169.05 | $2,415.00 | $40.00 – $1,295.60 | 34 |
| Opn tx orbit periorbtl implt CPT 21390 | $195.86 | $2,798.00 | $75.00 – $1,478.32 | 34 |
| Opscpy extnd on/mac draw CPT 92202 | $2.59 | $37.00 | $11.97 – $25.51 | 34 |
| Optx acrclv dslc aq/chrn grf CPT 23552 | $159.39 | $2,277.00 | $60.00 – $1,297.98 | 34 |
| Optx acromclv dislc aqt/chrn CPT 23550 | $141.40 | $2,020.00 | $95.68 – $1,122.38 | 34 |
| Optx acute shoulder dislc CPT 23660 | $144.97 | $2,071.00 | $95.68 – $1,134.25 | 34 |
| Optx carpl scphd fx int fixj CPT 25628 | $178.22 | $2,546.00 | $407.00 – $1,400.01 | 34 |
| Optx clavicular fx w/int fix CPT 23515 | $177.38 | $2,534.00 | $75.95 – $1,136.62 | 34 |
| Optx complicated mndblr fx CPT 21470 | $284.06 | $4,058.00 | $35.00 – $2,320.70 | 34 |
| Optx crpl fx oth/thn scph ea CPT 25645 | $141.82 | $2,026.00 | $16.00 – $1,127.13 | 34 |
| Optx gr hmrl tbrs fx int fix CPT 23630 | $824.67 | $11,781.00 | $35.00 – $19,141.34 | 36 |
| Optx lunate dislocation CPT 25695 | $156.59 | $2,237.00 | $40.00 – $1,250.52 | 34 |
| Optx medial ankle fx CPT 27766 | $149.94 | $2,142.00 | $249.00 – $1,293.23 | 34 |
| Optx mndblr cndylr fx CPT 21465 | $198.24 | $2,832.00 | $65.00 – $1,796.29 | 34 |
| Optx mndblr fx wo ntrdntl CPT 21461 | $259.56 | $3,708.00 | $595.68 – $15,616.06 | 36 |
| Optx partclr fx&/dslc elbw w CPT 24587 | $263.55 | $3,765.00 | $45.00 – $2,171.20 | 34 |
| Optx post ankle fx CPT 27769 | $177.94 | $2,542.00 | $70.00 – $1,328.82 | 34 |
| Optx prox humrl fx w/int fix CPT 23615 | $1,513.82 | $21,626.00 | $60.00 – $33,867.40 | 36 |
| Optx prx hmrl fx fix rpr rpl CPT 23616 | $297.85 | $4,255.00 | $60.00 – $2,930.53 | 34 |
| Optx radial shaft fracture CPT 25515 | $166.25 | $2,375.00 | $337.30 – $1,376.28 | 34 |
| Optx rad/uln dislc aqt/chrnc CPT 25676 | $156.52 | $2,236.00 | $21.00 – $1,248.15 | 34 |
| Optx rdcrpl/ntrcrpl dislc 1+ CPT 25670 | $150.15 | $2,145.00 | $67.39 – $1,207.81 | 34 |
| Optx rdl shft fx&cltx rad/ul CPT 25525 | $194.95 | $2,785.00 | $126.21 – $1,848.49 | 34 |
| Optx rdl shft fx&dstl rad/ul CPT 25526 | $234.22 | $3,346.00 | $40.00 – $2,135.61 | 34 |
| Optx rdl&uln shft fx rds&uln CPT 25575 | $222.25 | $3,175.00 | $314.00 – $1,751.20 | 34 |
| Optx rdl&uln shft fx rds/uln CPT 25574 | $167.72 | $2,396.00 | $480.64 – $1,186.45 | 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.