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 |
|---|---|---|---|---|
| Stimulants synthetic CPT 80371 | $10.50 | $150.00 | $0.03 – $156.94 | 8 |
| Stot/tot hysterectomy after cesaren delivery 59525 CPT 59525 | $108.57 | $1,551.00 | $40.00 – $1,260.85 | 34 |
| Strapping of ankle and/or ft 29540 CPT 29540 | $18.55 | $265.00 | $15.28 – $304.00 | 36 |
| Strapping of chest CPT 29200 | $7.84 | $112.00 | $15.65 – $304.00 | 36 |
| Strapping of elbow or wrist 29260 CPT 29260 | $18.55 | $265.00 | $10.00 – $155.62 | 36 |
| Strapping of hand or finger CPT 29280 | $7.28 | $104.00 | $15.00 – $155.62 | 36 |
| Strapping of hip CPT 29520 | $8.61 | $123.00 | $15.65 – $304.00 | 36 |
| Strapping of knee CPT 29530 | $18.55 | $265.00 | $15.65 – $304.00 | 36 |
| Strapping of toes 29550 CPT 29550 | $4.90 | $70.00 | $9.61 – $155.62 | 36 |
| Strep a dna dir probe CPT 87650 | $1.40 | $20.05 | $7.45 – $213.35 | 23 |
| Strep b assay w/optic CPT 87802 | $0.89 | $12.73 | $2.78 – $98.83 | 23 |
| Strep b dna amp probe CPT 87653 | $29.54 | $422.00 | $8.40 – $377.54 | 23 |
| Stress test pulmonary CPT 94618 | $46.76 | $668.00 | $12.08 – $350.97 | 37 |
| Stress tte complete CPT 93351 | $342.02 | $4,886.00 | $83.32 – $2,011.45 | 37 |
| Str markers specimen anal CPT 81265 | $21.00 | $300.00 | $191.15 – $2,511.14 | 23 |
| St treatment speech individual CPT 92507 | $89.53 | $1,279.00 | $40.92 – $499.00 | 25 |
| St treatment swallow dysfunction/oral CPT 92526 | $89.53 | $1,279.00 | $48.51 – $499.00 | 24 |
| Subq i/p critical care pr day age 28 days/less than 99469 CPT 99469 | $67.55 | $965.00 | $143.52 – $690.31 | 36 |
| Subsequent intensive care infant 1500-2500 grams 99479 CPT 99479 | $21.21 | $303.00 | $104.41 – $226.49 | 34 |
| Subsequent intensive care infant 2501-5000 grams 99480 CPT 99480 | $20.30 | $290.00 | $98.63 – $304.00 | 36 |
| Subtalar arthro w/fb rmvl CPT 29904 | $157.71 | $2,253.00 | $95.00 – $1,191.20 | 34 |
| Subtalar arthro w/fusion CPT 29907 | $214.34 | $3,062.00 | $623.60 – $1,651.54 | 34 |
| Succinylcholine chloride 20 mg/ml injection solution (wrapper) HCPCS J0330 | $2.40 | $34.29 | $1.70 – $49.00 | 11 |
| Sugars single quant CPT 84378 | $0.81 | $11.53 | $4.21 – $126.07 | 23 |
| Sulfamethoxazole 400 mg-trimethoprim 80 mg/5 ml intravenous solution HCPCS J2865 | $0.14 | $2.00 | $0.04 – $2.86 | 10 |
| Sulfonylurea screen qn-sendout CPT 80377 | $8.79 | $125.59 | $0.03 – $218.38 | 8 |
| Sumatriptan 6 mg/0.5 ml subcutaneous solution HCPCS J3030 | $22.54 | $322.00 | $13.78 – $258.00 | 19 |
| Sup of prep of antigen # of vials 95144 CPT 95144 | $3.01 | $43.00 | $12.67 – $304.00 | 18 |
| Support clav 29.6-40.5in med HCPCS L3650 | $15.26 | $218.00 | $32.62 – $252.88 | 34 |
| Suprv interfacilty transport CPT 99485 | $10.01 | $143.00 | $87.51 – $184.95 | 15 |
| Suprv interfac trnsport addl CPT 99486 | $8.75 | $125.00 | $75.78 – $150.00 | 15 |
| Surg dx exam anorectal CPT 45990 | $25.20 | $360.00 | $58.00 – $7,321.98 | 36 |
| Surg ect salp-oophorectomy 59120 CPT 59120 | $189.63 | $2,709.00 | $40.00 – $1,673.38 | 36 |
| Surg ect without salp-oophorectomy 59121 CPT 59121 | $189.56 | $2,708.00 | $698.51 – $1,686.54 | 34 |
| Surgical opening of stomach 43500 CPT 43500 | $185.36 | $2,648.00 | $435.22 – $1,336.32 | 34 |
| Surgical pathology level 1 gross examination only CPT 88300 | $3.50 | $50.00 | $12.01 – $76.30 | 24 |
| Surgical pathology level 2 gross & microscopic examination CPT 88302 | $5.25 | $75.00 | $30.04 – $156.64 | 24 |
| Surgical pathology level 3 gross & microscopic examination CPT 88304 | $10.85 | $155.00 | $43.72 – $172.60 | 24 |
| Surgical pathology level 4 gross & microscopic examination CPT 88305 | $11.20 | $160.00 | $58.80 – $233.08 | 24 |
| Surgical pathology level 5 gross & microscopic examination CPT 88307 | $17.50 | $250.00 | $125.71 – $945.55 | 24 |
| Surgical pathology level 6 gross & microscopic examination CPT 88309 | $21.00 | $300.00 | $266.04 – $2,125.32 | 24 |
| Surgical repair stomach bleedin ulcer 43501 CPT 43501 | $314.09 | $4,487.00 | $80.00 – $2,446.28 | 36 |
| Surgical repair stomach gastric lac 43502 CPT 43502 | $354.76 | $5,068.00 | $75.00 – $2,643.93 | 34 |
| Surgical revision intestine CPT 44680 | $251.02 | $3,586.00 | $30.00 – $1,832.71 | 34 |
| Surg tx anal fistula 2nd stage 46285 CPT 46285 | $104.93 | $1,499.00 | $65.00 – $7,321.98 | 36 |
| Susceptibility agar dilution per agent CPT 87181 | $0.33 | $4.75 | $0.41 – $24.80 | 23 |
| Susceptibility enzyme detection per enzyme CPT 87185 | $5.88 | $84.00 | $0.33 – $31.68 | 23 |
| Susceptibility mic per plate CPT 87186 | $42.77 | $611.00 | $3.11 – $95.05 | 23 |
| Suscept studies macrobroth dilution ea CPT 87188 | $0.41 | $5.90 | $2.35 – $72.92 | 23 |
| Suspension of testis CPT 54620 | $71.96 | $1,028.00 | $35.00 – $518.21 | 34 |
| Suspension of uterus 58400 CPT 58400 | $15.19 | $217.00 | $217.00 – $918.25 | 34 |
| Sutr lg intestine 1/mult perf without colostomy 44604 CPT 44604 | $245.35 | $3,505.00 | $80.00 – $1,846.93 | 34 |
| Suture bile duct injury 47900 CPT 47900 | $322.07 | $4,601.00 | $176.47 – $2,349.56 | 34 |
| Svc venogram s&i CPT 75827 | $621.53 | $8,879.00 | $52.29 – $4,152.50 | 37 |
| Sympathectomy digital artery CPT 64820 | $187.53 | $2,679.00 | $65.00 – $1,809.74 | 34 |
| Sympathectomy supfc palmar CPT 64823 | $193.62 | $2,766.00 | $118.76 – $1,906.23 | 34 |
| Synvisc or synvisc-one HCPCS J7325 | $77.21 | $1,103.00 | $6.02 – $35.96 | 31 |
| Syphilis test non-treponemal antibody quantitative rpr CPT 86593 | $17.36 | $248.00 | $1.50 – $48.41 | 23 |
| System pacing micra av HCPCS C1786 | $4,627.00 | $66,100.00 | $13,068.00 – $16,335.00 | 4 |
| System pcmkr dual chamber leadless micra av2 intrdcr cath HCPCS C1785 | $2,209.34 | $31,562.00 | $15,955.00 – $19,943.75 | 4 |
| T3 (triiodothyronine) free CPT 84481 | $26.81 | $383.00 | $4.87 – $186.33 | 23 |
| T3 (triiodothyronine) total CPT 84480 | $16.17 | $231.00 | $5.22 – $155.83 | 23 |
| T4 (thyroxine) free CPT 84439 | $45.43 | $649.00 | $3.26 – $99.12 | 23 |
| T4 (thyroxine) total CPT 84436 | $32.69 | $467.00 | $2.44 – $75.58 | 23 |
| Tacrolimus 1 mg capsule, immediate-release HCPCS J7507 | $4.53 | $64.71 | $0.45 – $41.88 | 10 |
| Tacrolimus therapeutic drug level CPT 80197 | $14.91 | $213.00 | $5.05 – $163.16 | 23 |
| Tah w/mmk 58152 CPT 58152 | $293.02 | $4,186.00 | $70.00 – $2,636.36 | 34 |
| Tamoxifen 10 mg tabs 60 each bottle HCPCS S0187 | $1.75 | $25.00 | $0.52 – $35.73 | 8 |
| Tap block uni by cont infusion 64487 CPT 64487 | $14.00 | $200.00 | $8.00 – $425.93 | 34 |
| Target gsa panel hmtlmph neop CPT 81450 | $171.50 | $2,450.00 | $759.53 – $22,668.84 | 22 |
| Target gsa panel organ/hmtlmph neop CPT 81455 | $172.55 | $2,465.00 | $1,964.13 – $22,668.84 | 23 |
| Tbs dxa cal w/i&r fx risk CPT 77089 | $11.62 | $166.00 | $37.36 – $316.84 | 32 |
| Tb test cell mediated immunity antigen response enumeration gamma interferon t-cells CPT 86481 | $66.36 | $948.00 | $19.22 – $517.37 | 23 |
| Tb test cell mediated immunity antigen response gamma interferon CPT 86480 | $4.34 | $61.98 | $11.95 – $666.61 | 23 |
| Tc-99m bicisate HCPCS A9557 | $206.43 | $2,949.00 | $198.33 – $2,111.36 | 22 |
| Tc-99m labeled rbc HCPCS A9560 | $118.51 | $1,693.00 | $59.07 – $2,419.30 | 10 |
| Tc-99m maa HCPCS A9540 | $43.19 | $617.00 | $11.16 – $881.69 | 10 |
| Tc-99m mebrofenin HCPCS A9537 | $104.86 | $1,498.00 | $30.85 – $2,140.64 | 10 |
| Tc-99m medronate HCPCS A9503 | $41.86 | $598.00 | $25.98 – $854.54 | 10 |
| Tc-99m mertiatide HCPCS A9562 | $416.29 | $5,947.00 | $230.86 – $8,498.26 | 10 |
| Tc-99m pentetate dtpa HCPCS A9539 | $4.90 | $70.00 | $8.42 – $100.03 | 10 |
| Tc-99m pertechnetate per mci HCPCS A9512 | $2.38 | $34.00 | $0.90 – $48.59 | 10 |
| Tc-99m sestamibi p study dose HCPCS A9500 | $164.36 | $2,348.00 | $59.74 – $3,355.29 | 10 |
| Tc-99m succimer (dmsa) HCPCS A9551 | $206.43 | $2,949.00 | $65.62 – $1,796.65 | 22 |
| Tc-99m sulfur colloid HCPCS A9541 | $11.06 | $158.00 | $27.57 – $2,045.69 | 10 |
| Tc-99m tetrofosmin p study dose HCPCS A9502 | $32.90 | $470.00 | $58.76 – $671.63 | 10 |
| Tc-99m tilmanocept diag HCPCS A9520 | $98.21 | $1,403.00 | $126.72 – $2,004.89 | 8 |
| Tca peel dermal 15789 CPT 15789 | $133.91 | $1,913.00 | $152.00 – $361.06 | 18 |
| T cells absolute cd4/cd8 including ratio CPT 86360 | $3.29 | $46.98 | $17.52 – $433.87 | 23 |
| T cells absolute cd 4 count CPT 86361 | $1.87 | $26.78 | $10.01 – $296.11 | 23 |
| T cells total count CPT 86359 | $2.64 | $37.73 | $14.18 – $415.51 | 23 |
| Tcranial magn stim tx deli CPT 90868 | $40.32 | $576.00 | $177.87 – $11,048.83 | 7 |
| Tcranial magn stim tx plan CPT 90867 | $56.84 | $812.00 | $283.22 – $22,885.82 | 7 |
| Tcran magn stim redetemine CPT 90869 | $46.41 | $663.00 | $135.64 – $1,208.20 | 7 |
| Teaec w/wo patch graft iliofemoral CPT 35355 | $228.06 | $3,258.00 | $878.78 – $1,965.22 | 36 |
| Team conf without pat by phys CPT 99367 | $6.30 | $90.00 | $90.00 – $128.61 | 5 |
| Telehealth original site facility fee HCPCS Q3014 | $4.69 | $67.00 | $32.33 – $80.40 | 14 |
| Telethx isodose plan cplx CPT 77307 | $43.05 | $615.00 | $156.85 – $349.89 | 34 |
| Telethx isodose plan simple CPT 77306 | $20.72 | $296.00 | $76.17 – $168.02 | 34 |
| Tendon lngth upr a/e ea tdn CPT 24305 | $144.27 | $2,061.00 | $60.00 – $1,138.99 | 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.