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 |
|---|---|---|---|---|
| Pr exam init preventive phys new visit during 1st 12 mo of mcare enrollment HCPCS G0402 | $29.12 | $416.00 | $115.16 – $384.00 | 34 |
| Pr excision benign lesion scalp/neck/hands/feet/genitalia <= 0.5 cm CPT 11420 | $154.00 | $2,200.00 | $19.00 – $304.00 | 36 |
| Pr excision benign lesion trunk/arms/legs 3.1 - 4.0 cm CPT 11404 | $154.00 | $2,200.00 | $14.00 – $304.00 | 36 |
| Pr excision nail/nail matrix partial/complete permanent removal CPT 11750 | $71.40 | $1,020.00 | $44.00 – $304.00 | 36 |
| Pr gastrorrhaphy suture perforated duodenal or gastric ulcer/wound/ injury CPT 43840 | $317.52 | $4,536.00 | $40.00 – $10,170.44 | 36 |
| Prgrmg dev eval impltbl sys CPT 93260 | $7.07 | $101.00 | $33.77 – $268.16 | 37 |
| Prgrmg dev eval pm/ldls pm CPT 93279 | $14.56 | $208.00 | $28.13 – $183.28 | 37 |
| Prgrmg dev eval scrms ip CPT 93285 | $21.00 | $300.00 | $25.74 – $148.31 | 37 |
| Prgrmg eval implantable dfb CPT 93282 | $14.77 | $211.00 | $33.93 – $193.54 | 37 |
| Prgrmg eval implantable dfb CPT 93283 | $18.83 | $269.00 | $39.20 – $220.13 | 37 |
| Prgrmg eval implantable dfb CPT 93284 | $21.07 | $301.00 | $44.48 – $249.97 | 37 |
| Pr hospital ip/obs care initial high level per day CPT 99223 | $30.31 | $433.00 | $80.10 – $320.92 | 36 |
| Pr hospital ip/obs care initial moderate level per day CPT 99222 | $22.82 | $326.00 | $73.20 – $233.92 | 36 |
| Pr hospital ip/obs care initial straightforward or low level per day CPT 99221 | $14.35 | $205.00 | $34.30 – $157.25 | 36 |
| Pr hospital ip/obs care subsequent high level per day CPT 99233 | $20.72 | $296.00 | $45.80 – $304.00 | 36 |
| Pr hospital ip/obs care subsequent moderate level per day CPT 99232 | $13.79 | $197.00 | $37.80 – $304.00 | 36 |
| Pr hospital ip/obs care subsequent straightforward or low level per day CPT 99231 | $8.61 | $123.00 | $27.50 – $88.38 | 36 |
| Prim art mech thrmbc non-intracranial CPT 37184 | $2,072.91 | $29,613.00 | $60.00 – $48,357.40 | 36 |
| Prim art mech thrmbc non-intracranial add-on CPT 37185 | $1,643.88 | $23,484.00 | $65.00 – $1,596.88 | 36 |
| Pr incision & drainage abscess complicated/multiple CPT 10061 | $147.56 | $2,108.00 | $75.76 – $304.00 | 35 |
| Pr incision & drainage abscess simple/single CPT 10060 | $96.11 | $1,373.00 | $42.44 – $304.00 | 36 |
| Pr incision & drainage abscess vulva/perineal CPT 56405 | $36.96 | $528.00 | $90.70 – $304.00 | 36 |
| Pr incision & removal foreign body subcutaneous tissues simple CPT 10120 | $46.13 | $659.00 | $20.00 – $304.00 | 36 |
| Pr management transitional care high w/in 7 days of discharge CPT 99496 | $49.77 | $711.00 | $152.00 – $532.68 | 36 |
| Pr management transitional care moderate w/in 14 days of discharge CPT 99495 | $36.75 | $525.00 | $123.09 – $378.33 | 36 |
| Pr moderate sedation same physician >= 5 years initial 15 minutes CPT 99152 | $31.08 | $444.00 | $10.86 – $214.09 | 36 |
| Pr neuroplasty and/or transposition ulnar nerve at elbow CPT 64718 | $150.43 | $2,149.00 | $89.35 – $1,332.53 | 34 |
| Probe cryo 1150mm endo flex ster disp HCPCS C2618 | $795.90 | $11,370.00 | $8,331.00 – $11,905.00 | 5 |
| Probe nasolacrimal duct CPT 68810 | $39.90 | $570.00 | $45.00 – $482.61 | 36 |
| Probe nasolacrimal duct CPT 68811 | $33.32 | $476.00 | $22.34 – $370.44 | 34 |
| Procalcitonin CPT 84145 | $32.27 | $461.00 | $6.11 – $180.26 | 23 |
| Prochlorperazine edisylate 10 mg/2 ml (5 mg/ml) injection solution HCPCS J0780 | $11.94 | $170.61 | $1.81 – $20.88 | 19 |
| Proctectomy complete abd w/clst 45110 CPT 45110 | $427.35 | $6,105.00 | $80.00 – $3,213.80 | 34 |
| Proctosigmoidoscopy control bleed 45317 CPT 45317 | $26.32 | $376.00 | $86.00 – $392.38 | 34 |
| Proctosigmoidoscopy dilate 45303 CPT 45303 | $20.37 | $291.00 | $40.95 – $3,156.66 | 36 |
| Proctosigmoidoscopy dx 45300 CPT 45300 | $105.28 | $1,504.00 | $36.11 – $304.00 | 36 |
| Proctosigmoidoscopy volvul CPT 45321 | $24.36 | $348.00 | $25.00 – $168.54 | 34 |
| Proctosigmoidoscopy w/bx 45305 CPT 45305 | $17.50 | $250.00 | $50.63 – $317.71 | 34 |
| Progesterone CPT 84144 | $32.90 | $470.00 | $7.77 – $229.41 | 23 |
| Prolactin CPT 84146 | $26.39 | $377.00 | $7.20 – $213.05 | 23 |
| Prolng ip/obs e/m ea 15 min CPT 99418 | $9.80 | $140.00 | $46.91 – $135.60 | 15 |
| Prolng off/op e/m ea 15 min 99417 CPT 99417 | $7.42 | $106.00 | $37.36 – $304.00 | 27 |
| Prolong service without contact CPT 99358 | $16.17 | $231.00 | $74.00 – $304.00 | 27 |
| Prolong serv without contact add CPT 99359 | $10.99 | $157.00 | $61.28 – $304.00 | 27 |
| Promethazine hcl injection HCPCS J2550 | $1.33 | $19.00 | $0.51 – $22.04 | 19 |
| Proph rta dtchmnt pc CPT 67145 | $53.20 | $760.00 | $74.46 – $1,450.85 | 36 |
| Propofol infusion 10 mg/ml HCPCS J2704 | $52.38 | $748.29 | $0.07 – $196.93 | 11 |
| _propoxygc/msur CPT 80367 | $13.02 | $186.00 | $0.03 – $215.78 | 8 |
| Propranolol in ns IV syringe 0.1 mg/ml (neo/ped) - cnr HCPCS J1800 | $19.41 | $277.30 | $4.97 – $396.25 | 11 |
| Prostate ca screening; dre HCPCS G0102 | $3.43 | $49.00 | $5.32 – $58.80 | 32 |
| Prostatectomy (turp) CPT 52601 | $174.37 | $2,491.00 | $30.00 – $14,144.02 | 36 |
| Protamine 10 mg/ml intravenous solution HCPCS J2720 | $92.67 | $1,323.81 | $1.23 – $553.47 | 11 |
| Protein c activity CPT 85303 | $0.97 | $13.84 | $4.78 – $152.20 | 23 |
| Protein electrophoretic fractionation & quantitation serum CPT 84165 | $0.75 | $10.74 | $3.91 – $118.22 | 23 |
| Protein s total CPT 85305 | $0.81 | $11.61 | $4.24 – $127.84 | 23 |
| Protein total 24 hour urine CPT 84156 | $48.65 | $695.00 | $0.90 – $40.42 | 23 |
| Protein total body fluid CPT 84157 | $40.74 | $582.00 | $0.83 – $40.42 | 23 |
| Protein total serum plasma whole blood CPT 84155 | $40.88 | $584.00 | $1.21 – $40.27 | 23 |
| Prothrombin complex kcentra HCPCS J7168 | $2.74 | $39.09 | $1.52 – $10.63 | 23 |
| Prothrombin time substitution plasma fractions each CPT 85611 | $11.34 | $162.00 | $0.63 – $38.98 | 36 |
| Prpertl pel pack hemrrg trma 49013 CPT 49013 | $103.74 | $1,482.00 | $376.02 – $988.67 | 34 |
| Prp i/hern init block >5 yr CPT 49507 | $139.79 | $1,997.00 | $70.00 – $1,090.61 | 34 |
| Pr planning advance care 1st 30 minutes CPT 99497 | $14.28 | $204.00 | $66.48 – $267.99 | 36 |
| Pr prolonged e&m service office outpatient each 15 minutes (g2212) HCPCS G2212 | $5.53 | $79.00 | $27.47 – $91.20 | 34 |
| Prq av fstl crtj uxtr 1 acs CPT 36836 | $2,487.52 | $35,536.00 | $24,178.70 – $48,357.40 | 12 |
| Prq card revasc mi 1 vsl CPT 92941 | $108.57 | $1,551.00 | $541.18 – $1,731.36 | 34 |
| Prq card revasc mi 1 vsl drug-eluting HCPCS C9606 | $7,134.19 | $101,917.00 | $101,917.00 – $145,639.39 | 5 |
| Prq revasc byp graft 1 art and/or branches CPT 92937 | $96.67 | $1,381.00 | $482.46 – $1,543.51 | 34 |
| Prq skel fix epcndylr hum fx CPT 24566 | $179.13 | $2,559.00 | $319.06 – $1,359.67 | 34 |
| Prq skel fix sprcndlr hum fx CPT 24538 | $194.74 | $2,782.00 | $421.82 – $1,478.32 | 34 |
| Prq skel fix tarsl fx w/mnpj CPT 28456 | $94.92 | $1,356.00 | $30.00 – $585.51 | 34 |
| Prq tcat plmt ntrac st 1 les CPT 92928 | $4,127.98 | $58,971.15 | $439.73 – $30,452.80 | 36 |
| Prq tcat plmt ntrac st 2+les CPT 92930 | $9,856.56 | $140,808.00 | $74.00 – $48,357.40 | 21 |
| Prq trlml c athrc st angiop1 CPT 92933 | $108.43 | $1,549.00 | $524.81 – $1,728.00 | 34 |
| Prq trluml c angiop 1art&/br CPT 92920 | $2,188.83 | $31,269.00 | $367.08 – $15,013.92 | 36 |
| Prq trluml c athrc 1 art&/br CPT 92924 | $100.94 | $1,442.00 | $445.06 – $1,655.05 | 34 |
| Prq trluml revsc ch occ ant CPT 92943 | $105.77 | $1,511.00 | $541.18 – $1,731.36 | 34 |
| Pr removal drug delivery implant CPT 11982 | $46.06 | $658.00 | $22.34 – $304.00 | 36 |
| Pr removal foreign body external auditory canal without anesthesia CPT 69200 | $29.96 | $428.00 | $3.00 – $304.00 | 36 |
| Pr removal intrauterine device CPT 58301 | $36.96 | $528.00 | $5.00 – $304.00 | 36 |
| Pr repair intermediate wounds scalp/axillae/trunk/extremities 2.6 - 7.5 cm CPT 12032 | $75.95 | $1,085.00 | $91.59 – $411.56 | 36 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb <= 2.5 cm CPT 12011 | $27.65 | $395.00 | $38.00 – $304.00 | 36 |
| Pr repair sprfcl wd simple face/ears/eyelids/nose/lips/muc memb 2.6-5.0 cm CPT 12013 | $28.63 | $409.00 | $43.00 – $304.00 | 36 |
| Pr repair sprfcl wounds simple scalp/neck/axillae/gent/trunk/ext <= 2.5 cm CPT 12001 | $23.24 | $332.00 | $42.79 – $304.00 | 36 |
| Pr repair superficial wd simple scalp/neck/ax/gent/trunk/ext 2.6-7.5 cm CPT 12002 | $28.07 | $401.00 | $17.00 – $304.00 | 36 |
| Pr robotic surgical system HCPCS S2900 | $10.43 | $149.00 | $74.00 – $6,128.08 | 11 |
| Pr split-thickness autograft trunk/arm/leg 1st 100 sq cm/<tbsa infant/child CPT 15100 | $173.46 | $2,478.00 | $53.24 – $1,380.88 | 34 |
| Pr subsequent hospital care e/m normal newborn per day CPT 99462 | $7.14 | $102.00 | $25.20 – $304.00 | 36 |
| Prtl exc bone olecrn process CPT 24147 | $156.59 | $2,237.00 | $297.84 – $8,631.30 | 36 |
| Prtl excision bone clavicle CPT 23180 | $170.52 | $2,436.00 | $77.81 – $1,418.99 | 34 |
| Pr tube thoracostomy w/connection to drainage open CPT 32551 | $276.78 | $3,954.00 | $52.00 – $4,152.50 | 36 |
| Pr visit complexity e&m service serious/complex condition HCPCS G2211 | $2.73 | $39.00 | $0.01 – $74.00 | 34 |
| PSA (Prostate) Test CPT 84153 | $45.57 | $651.00 | $6.83 – $202.24 | 23 |
| Psychotherapy group therapy CPT 90853 | $5.04 | $72.00 | $3.47 – $67.71 | 34 |
| Psychotherapy patient individual therapy 30 minutes CPT 90832 | $18.55 | $265.00 | $18.98 – $468.22 | 36 |
| Psychotherapy patient individual therapy 45 minutes CPT 90834 | $18.69 | $267.00 | $67.16 – $468.22 | 36 |
| Psychotherapy patient individual therapy 60 minutes CPT 90837 | $27.65 | $395.00 | $131.97 – $468.22 | 36 |
| Psych test eval svc phys/qhp 1st hr CPT 96130 | $20.93 | $299.00 | $99.60 – $487.04 | 34 |
| Psy evaluation of records CPT 90885 | $9.73 | $139.00 | $56.42 – $166.80 | 15 |
| Psy/npsy phys/qhp 2> tst 1st 30 min CPT 96136 | $7.49 | $107.00 | $21.60 – $350.97 | 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.