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 |
|---|---|---|---|---|
| Sigmoidoscopy w/resection CPT 45349 | $51.94 | $742.00 | $74.00 – $566.69 | 27 |
| Sigmoidoscopy w/tumr remove CPT 45338 | $28.56 | $408.00 | $109.39 – $516.26 | 34 |
| Sigmoidoscopy w/ultrasound CPT 45341 | $29.47 | $421.00 | $25.00 – $387.36 | 34 |
| Sigmoidoscopy w/us guide bx CPT 45342 | $40.11 | $573.00 | $20.00 – $591.51 | 34 |
| Sigmoid/rmv tumor/polyp/hot bx for 45333 CPT 45333 | $105.28 | $1,504.00 | $86.71 – $2,453.16 | 36 |
| Sig w/tndsc balloon dilation CPT 45340 | $18.62 | $266.00 | $73.04 – $798.50 | 34 |
| Simple cystometrogram 51725 CPT 51725 | $52.08 | $744.00 | $36.05 – $304.00 | 36 |
| Sinus CT scan (with and without contrast) CPT 70488 | $748.16 | $10,688.00 | $33.20 – $1,987.73 | 37 |
| Sinus CT scan (with contrast) CPT 70487 | $683.76 | $9,768.00 | $29.55 – $1,594.51 | 37 |
| Sinus CT scan (without contrast) CPT 70486 | $402.50 | $5,750.00 | $22.36 – $1,330.48 | 37 |
| Sinus/juglr venogram s&i CPT 75860 | $14.56 | $208.00 | $53.59 – $8,329.20 | 31 |
| Sinusotomy maxillary sinus 31020 CPT 31020 | $129.85 | $1,855.00 | $56.00 – $732.78 | 34 |
| Sinusotomy sinus remove polyps 31032 CPT 31032 | $147.56 | $2,108.00 | $89.35 – $1,160.93 | 34 |
| Skeletal muscle relaxant 1/2 CPT 80369 | $12.46 | $178.00 | $0.03 – $177.96 | 8 |
| Skel musc relaxant 3 or more CPT 80370 | $0.42 | $6.00 | $0.03 – $195.73 | 8 |
| Skin Biopsy CPT 11102 | $86.17 | $1,231.00 | $30.14 – $304.00 | 36 |
| Skin full graft 20sq cm less 15200 CPT 15200 | $164.15 | $2,345.00 | $60.00 – $5,442.78 | 36 |
| Skin full graft add-on 15241 CPT 15241 | $25.27 | $361.00 | $87.91 – $273.47 | 36 |
| Skin pedicle flap trunk CPT 15570 | $176.26 | $2,518.00 | $30.00 – $1,348.38 | 34 |
| Skin split graft addl 100sq cm 15101 CPT 15101 | $25.97 | $371.00 | $98.65 – $324.91 | 27 |
| Skyla, 13.5 mg HCPCS J7301 | $127.89 | $1,827.00 | $1,011.38 – $2,192.40 | 18 |
| Slco1b1 gene com variants CPT 81328 | $11.46 | $163.75 | $163.75 – $1,375.57 | 22 |
| Sleep study attended CPT 95807 | $10.01 | $143.00 | $60.74 – $1,804.38 | 37 |
| Sleep Study (Polysomnography) CPT 95810 | $512.19 | $7,317.00 | $122.56 – $2,265.30 | 37 |
| Sleep study unattended CPT 95806 | $92.75 | $1,325.00 | $45.90 – $1,505.90 | 37 |
| Sleeve fing rolyan med HCPCS L3933 | $70.63 | $1,009.00 | $168.08 – $465.78 | 17 |
| Sling arm deluxe w/pad xs HCPCS A4565 | $5.60 | $80.00 | $2.61 – $32.40 | 34 |
| Sling suprapubic suburetheral HCPCS C1771 | $3,967.95 | $56,685.00 | $74.00 – $3,600.00 | 9 |
| Slitting of prepuce CPT 54001 | $34.37 | $491.00 | $131.23 – $5,514.28 | 36 |
| Slp pure tone screening CPT 92551 | $5.46 | $78.00 | $14.30 – $93.60 | 15 |
| Slp stdy unatnd w/anal CPT 95801 | $17.57 | $251.00 | $42.09 – $382.89 | 37 |
| Small bowel endoscopy CPT 44360 | $34.02 | $486.00 | $15.00 – $389.98 | 34 |
| Small bowel endoscopy CPT 44364 | $48.23 | $689.00 | $15.00 – $549.63 | 34 |
| Small bowel endoscopy CPT 44366 | $56.49 | $807.00 | $211.15 – $646.47 | 34 |
| Small bowel endoscopy CPT 44369 | $57.89 | $827.00 | $10.00 – $659.56 | 34 |
| Small bowel endoscopy CPT 44376 | $66.92 | $956.00 | $30.00 – $761.63 | 34 |
| Small bowel endoscopy CPT 44378 | $90.30 | $1,290.00 | $334.91 – $1,031.22 | 34 |
| Small bowel endoscopy CPT 44382 | $17.78 | $254.00 | $20.00 – $201.53 | 34 |
| Small bowel endoscopy CPT 44384 | $36.05 | $515.00 | $133.82 – $350.72 | 27 |
| Small bowel endoscopy >2nd w/remove 44363 CPT 44363 | $45.22 | $646.00 | $169.02 – $5,061.94 | 36 |
| Small bowel endoscopy/biopsy CPT 44361 | $37.59 | $537.00 | $30.00 – $429.24 | 34 |
| Small bowel endoscopy/biopsy CPT 44377 | $70.14 | $1,002.00 | $260.94 – $803.51 | 34 |
| Small bowel endoscopy br/wa CPT 44380 | $13.93 | $199.00 | $20.00 – $170.12 | 34 |
| Small bowel endoscopy br/wa CPT 44381 | $20.16 | $288.00 | $50.00 – $350.72 | 34 |
| Smear fluorescent and/or acid fast stain CPT 87206 | $35.91 | $513.00 | $0.29 – $53.17 | 36 |
| Smear gram stain CPT 87205 | $33.32 | $476.00 | $1.45 – $46.93 | 23 |
| Smear nasal eosinophil CPT 89190 | $33.18 | $474.00 | $4.63 – $52.19 | 24 |
| Smear special stain inclusion bodies/parasites CPT 87207 | $40.74 | $582.00 | $2.11 – $65.88 | 23 |
| Smear wet mount CPT 87210 | $39.62 | $566.00 | $1.34 – $42.24 | 36 |
| Smpd1 gene common variants CPT 81330 | $3.29 | $47.00 | $47.00 – $814.82 | 22 |
| Snrpn/ube3a gene CPT 81331 | $23.45 | $335.00 | $51.07 – $424.17 | 23 |
| Sodium 24 hour urine CPT 84300 | $49.56 | $708.00 | $1.46 – $53.45 | 23 |
| Sodium chloride 0.9 % intravenous solution HCPCS J7030 | $15.24 | $217.73 | $1.95 – $13.20 | 19 |
| Sodium chloride 0.9 % IV bolus HCPCS J7040 | $11.77 | $168.20 | $1.26 – $15.60 | 19 |
| Sodium chloride 0.9 % IV bolus HCPCS J7050 | $12.01 | $171.61 | $0.92 – $245.22 | 11 |
| Sodium chloride 3 % ivpb HCPCS J7131 | $16.25 | $232.16 | $0.04 – $294.70 | 10 |
| Sodium hyaluronate 20 mg/2 ml syringe HCPCS J7321 | $81.76 | $1,168.00 | $67.61 – $262.80 | 19 |
| Sodium serum/plasma/whole blood CPT 84295 | $40.74 | $582.00 | $1.46 – $52.71 | 23 |
| Sp bone agrft morsel add-on CPT 20937 | $38.36 | $548.00 | $35.00 – $353.56 | 34 |
| Sp bone agrft struct add-on CPT 20938 | $41.72 | $596.00 | $139.61 – $386.78 | 34 |
| Sp bone algrft morsel add-on CPT 20930 | $51.45 | $735.00 | $138.94 – $882.00 | 15 |
| Special radiation dosimetry CPT 77331 | $12.95 | $185.00 | $27.73 – $76.63 | 34 |
| Special radiation treatment CPT 77470 | $30.17 | $431.00 | $109.69 – $185.84 | 34 |
| Special supplies phys/qhp CPT 99070 | $683.85 | $9,769.27 | $1.06 – $74.00 | 11 |
| Special teletx port plan CPT 77321 | $14.07 | $201.00 | $51.34 – $98.05 | 34 |
| Specific gravity body fluid CPT 84315 | $22.54 | $322.00 | $0.78 – $27.61 | 23 |
| Specimen fat stain CPT 89125 | $0.41 | $5.88 | $5.88 – $47.45 | 24 |
| Speech evaluation complex CPT 70371 | $269.01 | $3,843.00 | $314.71 – $2,849.43 | 22 |
| Speech recep thresh CPT 92555 | $5.95 | $85.00 | $11.20 – $155.62 | 36 |
| Sperm antibody test CPT 89325 | $3.38 | $48.25 | $10.67 – $117.33 | 23 |
| Sphenoid sinus surgery CPT 31051 | $256.62 | $3,666.00 | $84.88 – $1,293.48 | 34 |
| Sphincteroplasty inc/prolapse adult 46750 CPT 46750 | $179.34 | $2,562.00 | $50.00 – $1,277.92 | 34 |
| Spinal bone allograftstructural 20931 CPT 20931 | $25.20 | $360.00 | $83.77 – $234.92 | 34 |
| Spinal bone autograftlocal 20936 CPT 20936 | $56.49 | $807.00 | $146.22 – $968.40 | 15 |
| Spinal puncture lumbar diagnostic w/fluoroscopic or CT guidance CPT 62328 | $552.44 | $7,892.00 | $18.00 – $618.02 | 36 |
| Spirometry bronchodilation responsiveness pre/post bronchodilator administration CPT 94060 | $58.17 | $831.00 | $10.61 – $984.36 | 37 |
| Splenectomy total open 38100 CPT 38100 | $268.10 | $3,830.00 | $95.00 – $2,257.88 | 34 |
| Splint dorsal bloc wh med perf 3.2mm lf polyflex ii HCPCS L3906 | $101.64 | $1,452.00 | $217.32 – $1,684.32 | 34 |
| Splint extn xsm w sof-stretch rolyan HCPCS L3925 | $12.32 | $176.00 | $27.15 – $204.16 | 32 |
| Splint finger 4 prong foam sm HCPCS A4570 | $51.73 | $739.00 | $6.50 – $30.46 | 14 |
| Splint finger frog med HCPCS L3927 | $6.58 | $94.00 | $17.09 – $109.04 | 32 |
| Splint func pos polyflex ii med HCPCS L3999 | $3.08 | $44.00 | $38.00 – $74.00 | 10 |
| Splint rstrc wrst/cmc right med HCPCS L3923 | $16.80 | $240.00 | $22.26 – $278.40 | 32 |
| Split atogrft f/s/n/h/f/g/m/d gt 1st 100sqcm/</1 % CPT 15120 | $167.58 | $2,394.00 | $20.00 – $1,383.58 | 34 |
| Splt agrft f/s/n/h/f/g/m ea CPT 15121 | $31.01 | $443.00 | $55.00 – $438.63 | 34 |
| St analysis behavior qualitative voice/resonance CPT 92524 | $89.53 | $1,279.00 | $85.48 – $499.00 | 25 |
| Staph a dna amp probe CPT 87640 | $34.72 | $496.00 | $8.59 – $377.54 | 23 |
| St cognitve performance testing healthcare professional each hour CPT 96125 | $39.27 | $561.00 | $91.47 – $499.00 | 24 |
| Stenger test speech CPT 92577 | $5.46 | $78.00 | $13.61 – $46.18 | 34 |
| Stent axios caut enh 15x10mm electrocaut HCPCS C1874 | $2,111.13 | $30,159.00 | $5,625.00 – $7,031.25 | 4 |
| Stent bili dbl pgtl 10fx5cm HCPCS C2617 | $265.09 | $3,787.00 | $74.00 – $480.00 | 9 |
| Stent bili rx wallflx 10x80 uncvr HCPCS C1876 | $2,209.34 | $31,562.00 | $1,008.00 – $1,260.00 | 4 |
| Stereotactic radiation trmt CPT 77432 | $118.79 | $1,697.00 | $284.32 – $719.17 | 34 |
| Sterile water/saline, 10 ml HCPCS A4216 | $13.18 | $188.32 | $0.63 – $14.27 | 18 |
| Sterile water/saline, 500 ml HCPCS A4217 | $23.45 | $335.00 | $3.80 – $12.30 | 18 |
| Sternal debridement CPT 21627 | $132.72 | $1,896.00 | $146.31 – $8,631.30 | 36 |
| St evaluate speech sound production CPT 92522 | $89.53 | $1,279.00 | $88.28 – $499.00 | 25 |
| St evaluate speech sound production comprehensive/expressive CPT 92523 | $109.76 | $1,568.00 | $169.00 – $554.03 | 25 |
| St evaluation motion fluoroscopic swallow function cine/video CPT 92611 | $171.57 | $2,451.00 | $55.01 – $499.00 | 24 |
| St evaluation swallow function CPT 92610 | $135.31 | $1,933.00 | $59.71 – $499.00 | 24 |
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.