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 |
|---|---|---|---|---|
| Tx phalangeal shaft fx open prox/middle ea CPT 26735 | $148.75 | $2,125.00 | $10.00 – $8,631.30 | 36 |
| Tx septic abortion surgical 59830 CPT 59830 | $108.99 | $1,557.00 | $65.00 – $926.15 | 34 |
| Tx tarsal bone fx without manip 28450 CPT 28450 | $54.88 | $784.00 | $152.00 – $382.70 | 35 |
| Tympanic membrane repair CPT 69610 | $94.01 | $1,343.00 | $45.00 – $644.35 | 36 |
| Tympanolysis transcanal 69450 CPT 69450 | $134.96 | $1,928.00 | $50.00 – $835.56 | 36 |
| Tympanometry & reflex thresh CPT 92550 | $5.46 | $78.00 | $17.67 – $569.59 | 36 |
| Tympanostomy/ven tube/loc/top anes 69433 CPT 69433 | $75.60 | $1,080.00 | $50.00 – $304.00 | 36 |
| Ua w/micro/comp poc CPT 81000 | $8.26 | $118.00 | $0.64 – $31.25 | 36 |
| Ugt1a1 gene analy common variants CPT 81350 | $16.25 | $232.12 | $156.64 – $468.00 | 22 |
| Ultrasound abdomen aorta screening study aaa CPT 76706 | $126.63 | $1,809.00 | $26.01 – $682.70 | 37 |
| Ultrasound breast complete CPT 76641 | $159.46 | $2,278.00 | $34.35 – $667.37 | 37 |
| Ultrasound breast unilateral limited (both sides) CPT 76642 | $239.19 | $3,417.00 | $31.92 – $510.87 | 37 |
| Ultrasound chest CPT 76604 | $194.95 | $2,785.00 | $21.23 – $369.76 | 37 |
| Ultrasound doppler velocimetry fetal umbilical artery CPT 76820 | $178.22 | $2,546.00 | $24.69 – $452.98 | 37 |
| Ultrasound dx ophth b-scan CPT 76512 | $13.65 | $195.00 | $31.67 – $87.47 | 34 |
| Ultrasound elastography ea l target les CPT 76983 | $67.55 | $965.00 | $64.66 – $389.75 | 21 |
| Ultrasound elastography parenchyma CPT 76981 | $134.96 | $1,928.00 | $25.53 – $805.88 | 37 |
| Ultrasound encephalogram CPT 76506 | $192.15 | $2,745.00 | $29.86 – $347.18 | 37 |
| Ultrasound exam k transpl w/doppler CPT 76776 | $199.15 | $2,845.00 | $34.96 – $530.39 | 37 |
| Ultrasound fetal biophysical profile without non-stress testing CPT 76819 | $270.55 | $3,865.00 | $37.54 – $465.37 | 37 |
| Ultrasound guidance for vascular access CPT 76937 | $81.27 | $1,161.00 | $13.68 – $126.85 | 37 |
| Ultrasound guided needle placement supervision & interpretation CPT 76942 | $267.96 | $3,828.00 | $32.13 – $430.72 | 37 |
| Ultrasound guide intraoperative CPT 76998 | $131.81 | $1,883.00 | $33.47 – $642.59 | 35 |
| Ultrasound guide tissue ablation CPT 76940 | $26.95 | $385.00 | $76.95 – $479.63 | 35 |
| Ultrasound hips infant dynamic CPT 76885 | $200.13 | $2,859.00 | $34.69 – $432.59 | 37 |
| Ultrasound infant hips ltd without stress CPT 76886 | $159.46 | $2,278.00 | $29.15 – $402.08 | 37 |
| Ultrasound joint complete left CPT 76881 | $192.15 | $2,745.00 | $18.34 – $646.72 | 37 |
| Ultrasound joint/nonvascular extremity limited left CPT 76882 | $233.31 | $3,333.00 | $14.43 – $275.78 | 37 |
| Ultrasound ob >=14wks ea addl gest CPT 76810 | $89.81 | $1,283.00 | $48.15 – $768.57 | 37 |
| Ultrasound pregnant uterus < 14 weeks each additional gestation CPT 76802 | $79.80 | $1,140.00 | $40.31 – $219.46 | 37 |
| Ultrasound pregnant uterus detailed fetal exam single/1st gestation CPT 76811 | $142.66 | $2,038.00 | $92.83 – $1,053.73 | 37 |
| Ultrasound pregnant uterus follow up per fetus CPT 76816 | $95.27 | $1,361.00 | $40.95 – $275.78 | 37 |
| Ultrasound pregnant uterus limited >= 1 fetuses CPT 76815 | $147.77 | $2,111.00 | $31.27 – $385.09 | 37 |
| Ultrasound pregnant uterus transvaginal CPT 76817 | $134.05 | $1,915.00 | $36.13 – $443.32 | 37 |
| Ultrasound prostate/transrectal CPT 76872 | $57.61 | $823.00 | $32.69 – $385.89 | 37 |
| Ultrasound retroperitoneal limited CPT 76775 | $133.56 | $1,908.00 | $27.59 – $402.81 | 37 |
| Ultrasound scrotum and contents CPT 76870 | $199.99 | $2,857.00 | $30.20 – $389.15 | 37 |
| Ultrasound spinal canal and contents CPT 76800 | $267.68 | $3,824.00 | $44.60 – $407.74 | 37 |
| Ultrasound transabd ea addl gest CPT 76812 | $23.38 | $334.00 | $87.63 – $159.48 | 34 |
| Ultrasound transvaginal non obstetric CPT 76830 | $132.51 | $1,893.00 | $32.99 – $434.32 | 37 |
| Umbilical artery cath newborn 36660 CPT 36660 | $16.10 | $230.00 | $25.00 – $125.83 | 34 |
| Umbilicoplasty 15847 CPT 15847 | $151.06 | $2,158.00 | $273.22 – $2,589.60 | 15 |
| Unlistd noninvas vasc dx std CPT 93998 | $3.29 | $47.00 | $74.00 – $118.06 | 2 |
| Unlisted dx gi procedure CPT 91299 | $124.60 | $1,780.00 | $169.72 – $339.43 | 12 |
| Unlisted hematology&coagj px CPT 85999 | $3.08 | $44.02 | $44.02 – $62.90 | 5 |
| Unlisted laparoscopic liver biopy 47379 CPT 47379 | $257.39 | $3,677.00 | $38.00 – $15,947.64 | 14 |
| Unlisted laparoscopic procedure 49659 CPT 49659 | $75.04 | $1,072.00 | $74.00 – $1,316.25 | 2 |
| Unlisted laparoscopic reduction intestine 44238 CPT 44238 | $298.41 | $4,263.00 | $38.00 – $192.00 | 9 |
| Unlisted laparoscopy procedure biliary tract 47579 CPT 47579 | $24.36 | $348.00 | $38.00 – $186.00 | 9 |
| Unlisted laps px bladder CPT 51999 | $394.31 | $5,633.00 | $38.00 – $38.00 | 1 |
| Unlisted laps px ovidct ovry CPT 58679 | $63.84 | $912.00 | $38.00 – $150.00 | 9 |
| Unlisted laps px renal CPT 50549 | $181.30 | $2,590.00 | $38.00 – $156.00 | 9 |
| Unlisted laps px spleen CPT 38129 | $316.47 | $4,521.00 | $38.00 – $150.00 | 9 |
| Unlisted laps px uterus CPT 58578 | $140.14 | $2,002.00 | $38.00 – $150.00 | 9 |
| Unlisted misc path test CPT 89240 | $0.65 | $9.35 | $68.73 – $137.47 | 15 |
| Unlisted oph svc/procedure CPT 92499 | $4.27 | $61.00 | $38.00 – $332.00 | 20 |
| Unlisted procedure microbiology CPT 87999 | $31.01 | $443.00 | $443.00 – $633.05 | 5 |
| Unlisted procedure rectum CPT 45999 | $84.14 | $1,202.00 | $38.00 – $96.00 | 9 |
| Unlisted procedure urinary 58750 CPT 58750 | $216.16 | $3,088.00 | $788.76 – $3,705.60 | 34 |
| Unlisted px abdomen muscskel CPT 22999 | $148.47 | $2,121.00 | $38.00 – $78.00 | 9 |
| Unlisted px accessory sinus CPT 31299 | $30.73 | $439.00 | $38.00 – $74.00 | 2 |
| Unlisted px ant segment eye CPT 66999 | $44.10 | $630.00 | $38.00 – $6,087.86 | 14 |
| Unlisted px arthroscopy CPT 29999 | $172.06 | $2,458.00 | $38.00 – $74.00 | 9 |
| Unlisted px casting/strpg CPT 29799 | $60.76 | $868.00 | $169.00 – $499.00 | 18 |
| Unlisted px conjunctiva CPT 68399 | $18.13 | $259.00 | $38.00 – $837.29 | 21 |
| Unlisted px external ear CPT 69399 | $18.13 | $259.00 | $30.00 – $624.79 | 21 |
| Unlisted px foot/toes CPT 28899 | $382.62 | $5,466.00 | $35.00 – $304.00 | 21 |
| Unlisted px leg/ankle CPT 27899 | $205.87 | $2,941.00 | $38.00 – $74.00 | 2 |
| Unlisted px male genital sys CPT 55899 | $67.55 | $965.00 | $38.00 – $74.00 | 9 |
| Unlisted px middle ear CPT 69799 | $22.12 | $316.00 | $38.00 – $74.00 | 2 |
| Unlisted px neck/thorax CPT 21899 | $30.87 | $441.00 | $38.00 – $304.00 | 21 |
| Unlisted px pelvis/hip joint CPT 27299 | $18.13 | $259.00 | $38.00 – $650.69 | 14 |
| Unlisted px small intestine CPT 44799 | $384.16 | $5,488.00 | $38.00 – $74.00 | 9 |
| Unlisted px tongue flr mouth CPT 41599 | $19.18 | $274.00 | $38.00 – $74.00 | 2 |
| Unlisted special svc px/rprt CPT 99199 | $15.61 | $223.00 | $38.00 – $304.00 | 21 |
| Unlisted transfusion med px CPT 86999 | $4.55 | $65.00 | $38.15 – $689.00 | 15 |
| Unlisted ultrasound procedure CPT 76999 | $68.11 | $973.00 | $38.00 – $229.57 | 16 |
| Unsched dialysis esrd pt hos HCPCS G0257 | $255.78 | $3,654.00 | $625.00 – $5,221.57 | 20 |
| Upgrade pm system CPT 33214 | $110.88 | $1,584.00 | $55.00 – $871.65 | 34 |
| Upper Back (Thoracic Spine) MRI (with and without contrast) CPT 72157 | $934.92 | $13,356.00 | $59.96 – $6,169.78 | 37 |
| Upper Back (Thoracic Spine) MRI (with contrast) CPT 72147 | $860.72 | $12,296.00 | $46.77 – $3,763.06 | 37 |
| Upper Back (Thoracic Spine) MRI (without contrast) CPT 72146 | $846.79 | $12,097.00 | $38.83 – $3,477.97 | 37 |
| Upper Endoscopy (EGD, diagnostic) CPT 43235 | $108.22 | $1,546.00 | $35.00 – $2,392.56 | 36 |
| Upper Endoscopy (EGD, with biopsy) CPT 43239 | $108.22 | $1,546.00 | $35.00 – $2,392.56 | 36 |
| Uppr gi scope w/submuc inj CPT 43236 | $32.76 | $468.00 | $15.00 – $2,392.56 | 36 |
| Urachal cyst/sinus excision 51500 CPT 51500 | $154.00 | $2,200.00 | $65.00 – $1,089.03 | 34 |
| Urea nitrogen CPT 84520 | $49.07 | $701.00 | $1.32 – $43.38 | 23 |
| Urea nitrogen 24 hour urine CPT 84540 | $23.87 | $341.00 | $1.64 – $52.19 | 23 |
| Urea nitrogen clearance CPT 84545 | $0.41 | $5.88 | $2.34 – $72.55 | 23 |
| Ureteral embolization/occl CPT 50705 | $482.86 | $6,898.00 | $155.45 – $2,492.94 | 18 |
| Ureteral reflux study CPT 78740 | $7.42 | $106.00 | $27.80 – $278.13 | 34 |
| Ureter endoscopy & treatment CPT 50961 | $74.20 | $1,060.00 | $12.00 – $691.82 | 34 |
| Ureteroneocystostomy 50780 CPT 50780 | $264.39 | $3,777.00 | $40.00 – $1,875.55 | 34 |
| Ureteroureterostomy 50760 CPT 50760 | $267.47 | $3,821.00 | $447.00 – $1,883.44 | 34 |
| Urethrcystgrphy rtrgrde s&i CPT 74450 | $141.40 | $2,020.00 | $15.62 – $629.41 | 37 |
| Urethrlys transvag with scope CPT 53500 | $178.78 | $2,554.00 | $384.96 – $1,288.95 | 34 |
| Urethrocystography void s&i CPT 74455 | $273.49 | $3,907.00 | $15.99 – $629.41 | 37 |
| Uric acid blood CPT 84550 | $25.20 | $360.00 | $1.46 – $49.75 | 23 |
| Uric acid urine CPT 84560 | $0.36 | $5.08 | $1.80 – $52.19 | 23 |
| Urinalysis microscopic only CPT 81015 | $0.21 | $3.05 | $1.05 – $33.39 | 23 |
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.