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 |
|---|---|---|---|---|
| Rpr rem hernia init reduce CPT 49550 | $137.48 | $1,964.00 | $70.00 – $986.29 | 34 |
| Rpr xtnsr tndn leg prim without grft ea tndn CPT 27664 | $88.97 | $1,271.00 | $25.00 – $737.97 | 34 |
| Rsv assay w/optic CPT 87807 | $41.93 | $599.00 | $2.35 – $90.08 | 36 |
| Rubella antibody igg CPT 86762 | $18.20 | $260.00 | $4.23 – $157.75 | 23 |
| Rubeola antibody igg CPT 86765 | $18.20 | $260.00 | $4.74 – $141.69 | 23 |
| Russell viper venom diluted CPT 85613 | $2.66 | $38.00 | $3.32 – $105.19 | 23 |
| Salivary gland imaging CPT 78230 | $5.81 | $83.00 | $21.34 – $207.24 | 34 |
| Salmonella antibody CPT 86768 | $0.82 | $11.72 | $4.85 – $145.02 | 23 |
| Same day nb discharge 99463 CPT 99463 | $18.97 | $271.00 | $93.28 – $304.00 | 36 |
| Sars-cov-2 antb quantitative CPT 86413 | $34.30 | $490.00 | $46.31 – $147.39 | 23 |
| Sbrt management CPT 77435 | $179.69 | $2,567.00 | $536.14 – $1,177.08 | 34 |
| Sbsq ic vlbw inf<1,500 gm CPT 99478 | $23.31 | $333.00 | $116.59 – $245.13 | 34 |
| Sbsq nurs facil care/day unstabl/new prob 35 min 99310 CPT 99310 | $27.23 | $389.00 | $52.00 – $284.86 | 36 |
| Sbsq nursing facil care/day minor complj 15 min CPT 99308 | $13.23 | $189.00 | $27.50 – $138.78 | 36 |
| Sbsq nursing facil care/day new problem 25 min CPT 99309 | $19.18 | $274.00 | $40.00 – $200.62 | 36 |
| Sbsq nursing facility care/day e/m stable 10 min CPT 99307 | $7.14 | $102.00 | $13.70 – $75.70 | 36 |
| Sbsq psyc collab care mgmt CPT 99493 | $32.76 | $468.00 | $90.08 – $483.08 | 36 |
| Scan duplex abd/pelvis/retroperitoneal complete CPT 93975 | $275.03 | $3,929.00 | $53.54 – $1,418.23 | 37 |
| Scan duplex abd/pelvis/retroperitoneal limited CPT 93976 | $183.33 | $2,619.00 | $37.64 – $1,131.88 | 37 |
| Scan duplex aorta/ivc/iliac or bypass grafts complete CPT 93978 | $51.94 | $742.00 | $36.88 – $1,374.39 | 37 |
| Scan duplex aorta/ivc/iliac unilateral/limited CPT 93979 | $33.88 | $484.00 | $22.84 – $914.08 | 37 |
| Scan duplex extracranial arteries unilateral/limited study CPT 93882 | $139.37 | $1,991.00 | $21.08 – $880.50 | 37 |
| Scan duplex extremity veins unilateral/limited study CPT 93971 | $191.94 | $2,742.00 | $20.61 – $984.04 | 37 |
| Scan duplex lower extremity arteries complete bilateral CPT 93925 | $262.64 | $3,752.00 | $36.90 – $1,332.88 | 37 |
| Scan duplex lower extremity arteries unilateral/limited study left CPT 93926 | $183.33 | $2,619.00 | $22.30 – $889.83 | 37 |
| Scan duplex upper extremity arteries unilateral/limited study left CPT 93931 | $182.07 | $2,601.00 | $22.66 – $937.87 | 37 |
| Scan proc cranial extra CPT 61782 | $40.74 | $582.00 | $141.36 – $518.93 | 36 |
| Scan proc cranial intra 61781 CPT 61781 | $52.78 | $754.00 | $65.00 – $625.85 | 34 |
| Sclerotherapy fluid collection pq w/img CPT 49185 | $1,325.31 | $18,933.00 | $152.00 – $1,454.71 | 18 |
| Scope uretscp lithovue dig disp HCPCS C1747 | $1,008.00 | $14,400.00 | $1,350.00 – $1,929.15 | 5 |
| Screening Colonoscopy (average risk) HCPCS G0121 | $31.15 | $445.00 | $3.06 – $542.75 | 32 |
| Screening Colonoscopy (high risk) HCPCS G0105 | $31.92 | $456.00 | $3.06 – $2,453.16 | 34 |
| Screening colorectal cancer fecal occult blood immunoassay 1-3 simultaneous determinations HCPCS G0328 | $18.76 | $268.00 | $18.05 – $52.85 | 17 |
| Screening hepatitis c antibody high risk HCPCS G0472 | $8.12 | $116.00 | $18.08 – $143.54 | 32 |
| Screening Mammogram CPT 77067 | $9.94 | $142.00 | $35.74 – $138.61 | 34 |
| Screening prostate cancer PSA HCPCS G0103 | $48.86 | $698.00 | $8.79 – $182.02 | 35 |
| Screen/visual acuity/bilat/quant 99173 CPT 99173 | $12.53 | $179.00 | $3.65 – $78.00 | 15 |
| Screw cortex 2.0 x 10mm HCPCS C1713 | $7,619.99 | $108,857.00 | $6.00 – $502.86 | 9 |
| Sec abd wall suture evisceration/dehsn 49900 CPT 49900 | $196.98 | $2,814.00 | $328.00 – $1,638.56 | 36 |
| Sec art mech thrmbc non-intracranial add-on CPT 37186 | $54.60 | $780.00 | $65.00 – $3,285.28 | 36 |
| Sedimentation rate erythrocyte automated CPT 85652 | $23.73 | $339.00 | $0.85 – $28.72 | 23 |
| Segmentectomy 32484 CPT 32484 | $326.76 | $4,668.00 | $75.00 – $3,197.13 | 36 |
| Self-adher band w>=3" <5"/yd HCPCS A6454 | $0.21 | $3.00 | $0.35 – $3.60 | 32 |
| Self-meas bp 2 readg bid 30d CPT 99474 | $3.08 | $44.00 | $44.00 – $304.00 | 17 |
| Self-mgmt educ/train 2-4 pt 30min CPT 98961 | $3.57 | $51.00 | $16.00 – $61.20 | 15 |
| Self-mgmt educ/train 5-8 pt 30min CPT 98962 | $2.66 | $38.00 | $11.70 – $45.60 | 15 |
| Semen analysis presence/motility CPT 89321 | $31.01 | $443.00 | $12.05 – $132.43 | 23 |
| Semen analysis w/count CPT 89310 | $0.60 | $8.61 | $8.61 – $94.53 | 23 |
| Separate eyelid adhesions CPT 68340 | $97.16 | $1,388.00 | $45.00 – $1,025.22 | 34 |
| Serial tonometry CPT 92100 | $15.40 | $220.00 | $26.62 – $295.68 | 37 |
| Serpina1 gene CPT 81332 | $3.06 | $43.65 | $43.65 – $580.74 | 22 |
| Sertraline (zoloft) - sendout CPT 80332 | $14.00 | $200.00 | $0.03 – $180.77 | 8 |
| Set radiation therapy field CPT 77280 | $10.57 | $151.00 | $38.28 – $222.67 | 34 |
| Set radiation therapy field CPT 77285 | $15.89 | $227.00 | $57.69 – $403.35 | 34 |
| Set radiation therapy field CPT 77290 | $479.43 | $6,849.00 | $84.37 – $1,775.10 | 37 |
| Sgmdsc w/band ligation CPT 45350 | $24.01 | $343.00 | $92.41 – $868.36 | 27 |
| Shave sgl skin lsn f/e/e/n/l/m 0.5cm/< CPT 11310 | $28.70 | $410.00 | $8.00 – $304.00 | 36 |
| Shave sgl skin lsn f/e/e/n/l/m 0.6-1.0cm CPT 11311 | $34.02 | $486.00 | $8.00 – $304.00 | 36 |
| Shave sgl skin lsn f/e/e/n/l/m 1.1-2cm CPT 11312 | $38.64 | $552.00 | $13.00 – $304.00 | 36 |
| Shave sgl skin lsn f/e/e/n/l/m >2cm CPT 11313 | $44.87 | $641.00 | $8.00 – $304.00 | 36 |
| Shave sgl skin lsn s/n/h/f/g 0.5cm/< CPT 11305 | $26.11 | $373.00 | $25.69 – $304.00 | 36 |
| Shave sgl skin lsn s/n/h/f/g 0.6-1.0 cm CPT 11306 | $30.31 | $433.00 | $13.00 – $304.00 | 36 |
| Shave sgl skin lsn s/n/h/f/g 1.1-2cm CPT 11307 | $34.09 | $487.00 | $13.00 – $304.00 | 36 |
| Shave sgl skin lsn s/n/h/f/g >2cm CPT 11308 | $35.77 | $511.00 | $13.00 – $304.00 | 36 |
| Shave sgl skin lsn t/a/l 0.5cm/< CPT 11300 | $46.13 | $659.00 | $13.00 – $304.00 | 36 |
| Shave sgl skin lsn t/a/l 0.6-1.0cm CPT 11301 | $30.10 | $430.00 | $13.00 – $304.00 | 36 |
| Shave sgl skin lsn t/a/l 1.1-2.0cm CPT 11302 | $34.09 | $487.00 | $8.00 – $304.00 | 36 |
| Sheath gldlight lasr 12fx50cm HCPCS C2629 | $12.67 | $181.00 | $181.00 – $258.65 | 5 |
| Sho arthrs dx +- synovial bx CPT 29805 | $116.76 | $1,668.00 | $301.19 – $934.92 | 34 |
| Sho arthrs srg bicp tenodsis CPT 29828 | $222.60 | $3,180.00 | $65.00 – $1,770.18 | 34 |
| Sho arthrs srg capsulorraphy CPT 29806 | $256.97 | $3,671.00 | $36.00 – $2,123.75 | 34 |
| Sho arthrs srg compl synvct CPT 29821 | $146.44 | $2,092.00 | $285.00 – $1,179.33 | 34 |
| Sho arthrs srg lmtd dbrdmt CPT 29822 | $134.05 | $1,915.00 | $85.00 – $1,146.11 | 34 |
| Sho arthrs srg lss&rescj ads CPT 29825 | $144.69 | $2,067.00 | $70.00 – $1,167.47 | 34 |
| Sho arthrs srg prtl synvct CPT 29820 | $131.95 | $1,885.00 | $80.00 – $1,079.67 | 34 |
| Sho arthrs srg rmvl loose/fb CPT 29819 | $144.55 | $2,065.00 | $85.00 – $1,169.84 | 34 |
| Sho arthrs srg rpr slap les CPT 29807 | $251.23 | $3,589.00 | $31.00 – $2,071.54 | 34 |
| Sho arthrs srg xtnsv dbrdmt CPT 29823 | $145.81 | $2,083.00 | $50.00 – $1,250.52 | 34 |
| Shoe post-op mens m HCPCS L3260 | $42.70 | $610.00 | $8.01 – $49.20 | 15 |
| Shortening of hand tendon CPT 26479 | $168.49 | $2,407.00 | $60.00 – $1,305.10 | 34 |
| Shorten radius or ulna CPT 25390 | $189.21 | $2,703.00 | $92.70 – $1,933.91 | 34 |
| Shoulder Arthroscopy (Rotator Cuff Repair) CPT 29827 | $258.72 | $3,696.00 | $90.00 – $2,194.93 | 34 |
| Shoulder MRI (with and without contrast) CPT 73223 | $786.52 | $11,236.00 | $56.50 – $7,072.14 | 37 |
| Shoulder MRI (with contrast) CPT 73222 | $764.96 | $10,928.00 | $42.56 – $3,820.49 | 37 |
| Shoulder MRI (without contrast) CPT 73221 | $945.35 | $13,505.00 | $35.75 – $3,122.73 | 37 |
| Shoulder prosthesis removal CPT 23334 | $257.81 | $3,683.00 | $35.00 – $2,482.05 | 34 |
| Shoulder prosthesis removal CPT 23335 | $305.20 | $4,360.00 | $30.00 – $2,947.14 | 34 |
| Shoulder X-ray CPT 73030 | $147.00 | $2,100.00 | $9.22 – $229.57 | 37 |
| Shunt glaucoma baerveldt 350mm HCPCS C1783 | $756.00 | $10,800.00 | $74.00 – $5,280.00 | 9 |
| Shuntogram nonvascular supervision & interpretation CPT 75809 | $6.23 | $89.00 | $23.66 – $107.48 | 34 |
| Sialography s&i CPT 70390 | $83.65 | $1,195.00 | $17.69 – $629.41 | 37 |
| Sialolithotomy 42330 CPT 42330 | $58.24 | $832.00 | $55.00 – $342.40 | 36 |
| Sickling rbc CPT 85660 | $3.75 | $53.50 | $1.60 – $60.85 | 23 |
| Sigmoidoscopy and biopsy CPT 45331 | $105.28 | $1,504.00 | $67.67 – $304.00 | 36 |
| Sigmoidoscopy flex decompression 45337 CPT 45337 | $26.88 | $384.00 | $55.00 – $353.34 | 34 |
| Sigmoidoscopy for bleeding CPT 45334 | $27.93 | $399.00 | $20.00 – $408.30 | 34 |
| Sigmoidoscopy/submucosal injection 45335 CPT 45335 | $72.73 | $1,039.00 | $63.17 – $448.52 | 34 |
| Sigmoidoscopy w/ablation CPT 45346 | $37.94 | $542.00 | $74.00 – $539.87 | 27 |
| Sigmoidoscopy w/fb removal 45332 CPT 45332 | $25.06 | $358.00 | $55.00 – $474.82 | 34 |
| Sigmoidoscopy w/plcmt stent CPT 45347 | $36.40 | $520.00 | $74.00 – $263.96 | 27 |
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.