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 |
|---|---|---|---|---|
| Particle matristem matrix 1000mg micron-q4118-cost per mg HCPCS Q4118 | $892.57 | $12,751.00 | $1.79 – $8.40 | 17 |
| Part removal hip bone deep CPT 27071 | $236.46 | $3,378.00 | $75.00 – $1,803.40 | 34 |
| Part removal of metatarsal CPT 28110 | $73.71 | $1,053.00 | $289.88 – $743.85 | 27 |
| Part removal of metatarsal CPT 28113 | $107.03 | $1,529.00 | $203.28 – $8,631.30 | 36 |
| Part removal of metatarsal 28112 CPT 28112 | $78.05 | $1,115.00 | $198.81 – $813.92 | 34 |
| Path clin consltj sf 5-20 CPT 80503 | $9.73 | $139.00 | $23.04 – $137.47 | 23 |
| Patient recorded spirometry CPT 94014 | $10.08 | $144.00 | $26.62 – $92.69 | 34 |
| Patient recorded spirometry CPT 94015 | $5.88 | $84.00 | $14.43 – $55.73 | 33 |
| Pdgfra gene CPT 81314 | $26.99 | $385.50 | $329.51 – $2,705.17 | 23 |
| Pedcle fh/ch/ch/m/n/ax/g/h/f CPT 15574 | $176.12 | $2,516.00 | $116.16 – $1,345.68 | 34 |
| Ped crit care transport CPT 99466 | $40.53 | $579.00 | $193.96 – $414.09 | 34 |
| Ped crit care transport addl CPT 99467 | $20.30 | $290.00 | $96.79 – $212.14 | 34 |
| Ped critical care initial CPT 99471 | $135.24 | $1,932.00 | $152.00 – $1,396.11 | 36 |
| Ped critical care subsq CPT 99472 | $69.16 | $988.00 | $143.52 – $690.94 | 36 |
| Pedicle enel/ntroral 15576 CPT 15576 | $159.32 | $2,276.00 | $65.00 – $1,194.05 | 34 |
| Pelvic CT scan (with and without contrast) CPT 72194 | $712.81 | $10,183.00 | $31.90 – $2,373.61 | 37 |
| Pelvic CT scan (with contrast) CPT 72193 | $705.95 | $10,085.00 | $30.41 – $1,917.51 | 37 |
| Pelvic CT scan (without contrast) CPT 72192 | $622.16 | $8,888.00 | $28.62 – $1,659.07 | 37 |
| Pelvic MRI (with and without contrast) CPT 72197 | $851.62 | $12,166.00 | $59.21 – $7,085.06 | 37 |
| Pelvic MRI (with contrast) CPT 72196 | $775.18 | $11,074.00 | $45.47 – $3,135.73 | 37 |
| Pelvic MRI (without contrast) CPT 72195 | $712.32 | $10,176.00 | $38.35 – $3,197.29 | 37 |
| Pelvic Ultrasound (complete) CPT 76856 | $248.08 | $3,544.00 | $32.99 – $434.32 | 37 |
| Pelvic Ultrasound (limited) CPT 76857 | $159.53 | $2,279.00 | $24.14 – $298.68 | 37 |
| Peng benzathine/procaine inj HCPCS J0558 | $3.57 | $51.00 | $19.09 – $59.16 | 18 |
| Penicillin g benzathine 1,200,000 unit/2 ml intramuscular syringe HCPCS J0561 | $959.18 | $13,702.63 | $2.25 – $65.18 | 31 |
| Penicillin g potassium in ns IV syringe 100,000 units/ml (neo/ped) - cnr HCPCS J2540 | $22.28 | $318.28 | $1.12 – $424.94 | 11 |
| Penicillin g procaine inj HCPCS J2510 | $132.23 | $1,889.00 | $45.95 – $2,266.80 | 15 |
| Penile injection CPT 54235 | $28.42 | $406.00 | $27.54 – $304.00 | 36 |
| Penile rear tip xtnd 0.5cm HCPCS C2622 | $4,898.25 | $69,975.00 | $49,260.00 – $61,575.00 | 4 |
| Penile vascular study CPT 93980 | $16.31 | $233.00 | $61.37 – $1,053.99 | 37 |
| Penile vascular study CPT 93981 | $139.44 | $1,992.00 | $21.37 – $984.04 | 37 |
| Penis plastic surgery CPT 54360 | $173.39 | $2,477.00 | $152.00 – $1,262.64 | 36 |
| Perc cryo ablate renal tum CPT 50593 | $3,934.56 | $56,208.00 | $3,895.37 – $28,040.80 | 18 |
| Perc d-e cor revasc chro sin HCPCS C9607 | $102.20 | $1,460.00 | $74.00 – $1,752.00 | 9 |
| Perc d-e cor revasc t cabg b HCPCS C9605 | $1,364.16 | $19,488.00 | $19,488.00 – $27,848.35 | 5 |
| Perc d-e cor revasc t cabg s HCPCS C9604 | $2,425.01 | $34,643.00 | $38.00 – $30,452.80 | 21 |
| Perc d-e cor stent ather s HCPCS C9602 | $83.23 | $1,189.00 | $74.00 – $1,426.80 | 9 |
| Perc drug-el cor stent bran HCPCS C9601 | $44.17 | $631.00 | $74.00 – $1,891.31 | 9 |
| Perc drug-el cor stent sing HCPCS C9600 | $3,511.34 | $50,162.00 | $74.00 – $30,452.80 | 21 |
| Perc rf ablate renal tumor CPT 50592 | $2,370.48 | $33,864.00 | $65.55 – $15,947.64 | 13 |
| Percut ablate liver rf CPT 47382 | $2,523.71 | $36,053.00 | $762.83 – $15,947.64 | 18 |
| Pericardiocentesis wwo imaging CPT 33016 | $720.72 | $10,296.00 | $193.83 – $4,152.50 | 36 |
| Peri-implt capslc brst compl CPT 19371 | $173.67 | $2,481.00 | $421.82 – $1,578.51 | 34 |
| Perineoplasty rpr per nonob CPT 56810 | $65.31 | $933.00 | $240.00 – $8,539.30 | 36 |
| Peripheral vascular rehab CPT 93668 | $24.78 | $354.00 | $77.81 – $3,450.00 | 20 |
| Peri-proc device eval icd CPT 93287 | $3.71 | $53.00 | $19.69 – $110.04 | 37 |
| Peri-proc device eval pm CPT 93286 | $2.52 | $36.00 | $14.79 – $98.40 | 37 |
| Peritoneogram rs&i CPT 74190 | $5.95 | $85.00 | $21.99 – $332.94 | 34 |
| Perq dev breast 1st mr guide CPT 19287 | $29.54 | $422.00 | $20.00 – $2,010.89 | 34 |
| Perq nl/pl lithotrp cplx>2cm CPT 50081 | $267.54 | $3,822.00 | $632.54 – $24,971.80 | 36 |
| Perq rplcmt g-tube req revsn gstrst trk CPT 43763 | $81.97 | $1,171.00 | $60.31 – $1,031.51 | 36 |
| Perq skel fix rad/uln dislc CPT 25671 | $134.40 | $1,920.00 | $78.56 – $1,003.74 | 34 |
| Perq skel fix ulnar styld fx CPT 25651 | $123.48 | $1,764.00 | $320.18 – $899.33 | 34 |
| Perq tx big toe fracture w/manip 28496 CPT 28496 | $127.89 | $1,827.00 | $158.97 – $773.49 | 34 |
| Perq tx malar fracture CPT 21355 | $81.06 | $1,158.00 | $40.00 – $809.16 | 34 |
| Pessary 3.5 in 7 vag sil rng fold HCPCS A4562 | $12.18 | $174.00 | $24.30 – $108.34 | 25 |
| Pessary reusable rub anytype HCPCS A4561 | $14.84 | $212.00 | $9.76 – $56.86 | 28 |
| Pet CT skull-mid thgh initial CPT 78815 | $31.01 | $443.00 | $62.41 – $2,559.43 | 34 |
| Pet CT whole body initial CPT 78816 | $31.29 | $447.00 | $63.13 – $2,559.43 | 34 |
| Pet fdg brain metoblic eval sb CPT 78608 | $18.90 | $270.00 | $37.43 – $2,559.43 | 27 |
| Pet image full body CPT 78813 | $24.92 | $356.00 | $51.01 – $2,559.43 | 34 |
| Pet image skull-thigh CPT 78812 | $24.50 | $350.00 | $49.03 – $2,559.43 | 34 |
| Pet image w/ct lmtd CPT 78814 | $27.72 | $396.00 | $56.65 – $2,559.43 | 34 |
| Pfc sigma fem post aug sz3 8mm HCPCS C1776 | $6,075.65 | $86,795.00 | $74.00 – $11,747.84 | 9 |
| Ph1 assmt&mgmt nqhp 11-20 CPT 98967 | $4.27 | $61.00 | $20.27 – $67.20 | 36 |
| Ph1 assmt&mgmt nqhp 21-30 CPT 98968 | $5.95 | $85.00 | $29.50 – $93.60 | 36 |
| Ph1 assmt&mgmt nqhp 5-10 CPT 98966 | $2.31 | $33.00 | $10.50 – $34.80 | 36 |
| Phalangectomy ea toe 28150 CPT 28150 | $69.58 | $994.00 | $35.00 – $714.20 | 34 |
| Pharmacologic management w/psytx CPT 90863 | $7.98 | $114.00 | $32.93 – $137.53 | 14 |
| Ph body fluid CPT 83986 | $34.30 | $490.00 | $1.18 – $39.31 | 23 |
| Phencyclidine (pcp) CPT 83992 | $11.27 | $161.00 | $0.03 – $141.91 | 10 |
| Phenobarbital in ns IV syringe 10 mg/ml (neonate) - cnr HCPCS J2560 | $96.34 | $1,376.30 | $1.74 – $904.66 | 11 |
| Phenobarbital therapeutic drug level CPT 80184 | $50.33 | $719.00 | $4.17 – $125.70 | 23 |
| Phentolaine mesylate inj HCPCS J2760 | $621.47 | $8,878.11 | $16.32 – $1,144.97 | 23 |
| Phenylephrine 10 mg/ml injection solution HCPCS J2371 | $8.68 | $123.96 | $0.02 – $154.40 | 10 |
| Phenytoin total therapeutic drug level CPT 80185 | $39.62 | $566.00 | $4.87 – $145.76 | 23 |
| Phlebotomy therapeutic CPT 99195 | $43.75 | $625.00 | $16.40 – $350.97 | 36 |
| Phleb veins 1 extrm 10-20 stab CPT 37765 | $98.91 | $1,413.00 | $70.00 – $812.17 | 36 |
| Phleb veins 1 extrm >20 stab CPT 37766 | $75.53 | $1,079.00 | $75.00 – $8,329.20 | 36 |
| Phosphorus CPT 84100 | $40.81 | $583.00 | $1.46 – $52.04 | 23 |
| Phosphorus 24 hour urine CPT 84105 | $40.74 | $582.00 | $1.97 – $56.85 | 23 |
| Photo patch test CPT 95052 | $1.19 | $17.00 | $6.60 – $304.00 | 20 |
| Physician standby services CPT 99360 | $15.54 | $222.00 | $69.79 – $262.80 | 15 |
| Phytonadione (vitamin k1) 10 mg/ml injection solution HCPCS J3430 | $74.85 | $1,069.31 | $2.43 – $12.76 | 19 |
| Pin caspar distraction 12mm HCPCS C1821 | $1,656.97 | $23,671.00 | $23,671.00 – $29,588.75 | 4 |
| Pinch graft 1/mlt c> sm ulcer tip/oth area 2cm 15050 CPT 15050 | $145.32 | $2,076.00 | $152.00 – $785.20 | 36 |
| Pin finger dislocation CPT 26776 | $114.10 | $1,630.00 | $207.00 – $858.99 | 34 |
| Pin finger fracture each CPT 26756 | $107.73 | $1,539.00 | $45.00 – $8,631.30 | 36 |
| Pin hand dislocation CPT 26676 | $129.15 | $1,845.00 | $65.00 – $975.26 | 34 |
| Pinworm exam CPT 87172 | $39.62 | $566.00 | $0.73 – $42.24 | 36 |
| Piperacillin-tazobactam 3.375 gram intravenous solution HCPCS J2543 | $44.06 | $629.37 | $2.45 – $309.52 | 10 |
| Place cath xtrnl carotid CPT 36227 | $27.30 | $390.00 | $15.00 – $732.10 | 34 |
| Place device/marker, non pro HCPCS C9728 | $261.38 | $3,734.00 | $74.00 – $3,555.81 | 9 |
| Place duod/jej tube perc CPT 49441 | $56.42 | $806.00 | $70.00 – $2,054.30 | 34 |
| Place gastrostomy tube open 43832 CPT 43832 | $245.14 | $3,502.00 | $119.51 – $1,820.05 | 34 |
| Place gastrostomy tube perc CPT 49440 | $416.50 | $5,950.00 | $75.00 – $5,061.94 | 36 |
| Placement localization device(s) breast percutaneous mammographic guidance 1st lesion (both sides) CPT 19281 | $34.72 | $496.00 | $35.00 – $4,356.78 | 36 |
| Placement localization device(s) breast percutaneous mammographic guide ea addl lesion left CPT 19282 | $17.36 | $248.00 | $35.00 – $388.91 | 36 |
| Placement localization device(s) breast percutaneous ultrasound guidance 1st lesion (both sides) CPT 19285 | $852.25 | $12,175.00 | $20.00 – $1,868.00 | 36 |
| Placement nephrostomy catheter (both sides) CPT 50432 | $1,117.55 | $15,965.00 | $118.00 – $5,514.28 | 36 |
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.