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 |
|---|---|---|---|---|
| Urinalysis qual/semiquant excpt ia CPT 81005 | $0.63 | $9.00 | $0.20 – $4.90 | 33 |
| Urinalysis (with microscopy) CPT 81001 | $32.69 | $467.00 | $1.20 – $33.61 | 23 |
| Urinalysis (without microscopy) CPT 81003 | $29.05 | $415.00 | $0.20 – $22.25 | 36 |
| Urine Culture Test CPT 87086 | $35.91 | $513.00 | $2.09 – $87.50 | 23 |
| Urine flow measurement 51736 CPT 51736 | $3.36 | $48.00 | $8.70 – $304.00 | 36 |
| Urine pregnancy test CPT 81025 | $33.88 | $484.00 | $2.80 – $50.50 | 36 |
| Urine screen for bacteria CPT 81007 | $2.10 | $29.98 | $4.00 – $59.96 | 23 |
| Urography, antegrade CPT 74425 | $203.98 | $2,914.00 | $20.15 – $920.30 | 37 |
| Urography inf drip &/or bolus CPT 74410 | $202.72 | $2,896.00 | $56.39 – $1,084.89 | 23 |
| Use 1st target lesion CPT 76982 | $134.96 | $1,928.00 | $34.96 – $764.55 | 23 |
| Ustekinumab 130 mg/26 ml intravenous solution HCPCS J3358 | $1,949.66 | $27,852.33 | $6.89 – $34.01 | 23 |
| Vaccine covid-19 moderna >=12yrs 50mcg/0.5ml CPT 91322 | $28.28 | $404.00 | $84.04 – $484.80 | 13 |
| Vaccine covid-19 moderna 6mos-11yrs 25mcg/0.25ml CPT 91321 | $25.76 | $368.00 | $84.04 – $441.60 | 13 |
| Vaccine dtap < 7 years im CPT 90700 | $10.50 | $150.00 | $10.70 – $52.80 | 14 |
| Vaccine dtap-hep b-ipv im CPT 90723 | $93.45 | $1,335.00 | $12.00 – $133.43 | 14 |
| Vaccine dtap-ipv 4-6 years im CPT 90696 | $14.98 | $214.00 | $12.00 – $80.74 | 14 |
| Vaccine dtap-ipv/hib im CPT 90698 | $19.74 | $282.00 | $12.00 – $154.72 | 14 |
| Vaccine haemophilus influenzae type b (hib) prp-omp 3 dose im CPT 90647 | $4.97 | $71.00 | $12.00 – $52.80 | 14 |
| Vaccine haemophilus influenzae type b (hib) prp-t 4 dose im CPT 90648 | $14.42 | $206.00 | $12.00 – $52.80 | 14 |
| Vaccine hepatitis a (hepa) adult im CPT 90632 | $14.70 | $210.00 | $12.00 – $93.78 | 14 |
| Vaccine hepatitis a (hepa) hepatitis b (hepb) adult im CPT 90636 | $52.43 | $749.00 | $50.89 – $823.90 | 14 |
| Vaccine hepatitis a (hepa) pediatric/adolescent 2 dose im CPT 90633 | $10.43 | $149.00 | $12.00 – $52.80 | 14 |
| Vaccine hepatitis b (hepb) adolescent 2 dose im CPT 90743 | $13.16 | $188.00 | $38.60 – $225.60 | 14 |
| Vaccine hepatitis b (hepb) adult 3 dose im CPT 90746 | $81.01 | $1,157.28 | $29.31 – $211.20 | 14 |
| Vaccine hepatitis b (hepb) adult dosage 2 dose schedule im CPT 90739 | $29.47 | $421.00 | $174.44 – $505.20 | 13 |
| Vaccine hepatitis b (hepb) pediatric/adolescent 3 dose im CPT 90744 | $32.80 | $468.62 | $12.00 – $52.80 | 14 |
| Vaccine hpv types 6/11/16/18/31/33/45/52/58 nonvalent (9vhpv) 2 or 3 dose im CPT 90651 | $35.70 | $510.00 | $12.00 – $407.02 | 14 |
| Vaccine hpv types 6/11/16/18 quadrivalent (4vhpv) 3 dose im CPT 90649 | $28.49 | $407.00 | $12.00 – $198.01 | 14 |
| Vaccine influenza (iiv) preservative free antigen content im CPT 90662 | $14.63 | $209.00 | $15.13 – $229.90 | 14 |
| Vaccine influenza inactivated adjuvant im CPT 90653 | $88.64 | $1,266.30 | $29.23 – $250.80 | 14 |
| Vaccine influenza nos 0.5ml dose im CPT 90658 | $3.85 | $55.00 | $4.53 – $66.00 | 14 |
| Vaccine influenza preservative free trivalent (iiv3) 0.5ml dose im CPT 90656 | $22.14 | $316.22 | $7.94 – $52.80 | 14 |
| Vaccine influenza quadrivalent (iiv4) 0.5ml dose im CPT 90688 | $4.90 | $70.00 | $8.27 – $48.40 | 14 |
| Vaccine influenza quadrivalent (iiv4) inactivated adjuvanted preservative free 0.5ml dose im CPT 90694 | $21.70 | $310.00 | $10.37 – $231.60 | 14 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.25ml dose im CPT 90685 | $4.06 | $58.00 | $11.93 – $63.80 | 14 |
| Vaccine influenza quadrivalent (iiv4) preservative free 0.5ml dose im CPT 90686 | $4.76 | $68.00 | $9.83 – $52.80 | 14 |
| Vaccine influenza quadrivalent (iiv4) split virus 0.25 ml im CPT 90687 | $3.64 | $52.00 | $4.71 – $57.20 | 14 |
| Vaccine influenza quadrivalent live (laiv4) intranasal CPT 90672 | $4.13 | $59.00 | $27.44 – $70.80 | 13 |
| Vaccine influenza quadrivalent (riv4) rdna antibiotic/preservative free im CPT 90682 | $12.88 | $184.00 | $72.25 – $220.80 | 13 |
| Vaccine influenza trivalent (cciiv3) cell cultures subunit antibiotic free 0.5 ml im CPT 90661 | $6.44 | $92.00 | $18.10 – $110.40 | 14 |
| Vaccine influenza trivalent (iiv3) 0.25ml dose im CPT 90657 | $3.78 | $54.00 | $2.29 – $32.40 | 14 |
| Vaccine mengingoccocal serogroup b 2 dose im CPT 90620 | $32.62 | $466.00 | $12.00 – $293.23 | 14 |
| Vaccine mengingoccocal serogroup b 2 or 3 dose im CPT 90621 | $23.94 | $342.00 | $12.00 – $452.99 | 14 |
| Vaccine menigococcal serogroups a/c/w/y quadrivalent tetanus toxoid(menacwy-tt) im CPT 90619 | $73.15 | $1,045.00 | $87.87 – $1,254.00 | 13 |
| Vaccine meningococcal serogroups a/c/w/y quadrivalent diphtheria toxoid(menacwy-d/menacwy-crm) im CPT 90734 | $25.76 | $368.00 | $12.00 – $206.16 | 14 |
| Vaccine mmr live subcutaneous CPT 90707 | $62.37 | $891.00 | $12.00 – $121.47 | 14 |
| Vaccine mmrv live subcutaneous CPT 90710 | $56.56 | $808.00 | $12.00 – $357.16 | 14 |
| Vaccine pneumococcal 23 valent (ppsv23) subcutaneous/im CPT 90732 | $23.38 | $334.00 | $9.54 – $161.90 | 14 |
| Vaccine pneumococcal conjugate 13 valent (pcv13) im CPT 90670 | $45.15 | $645.00 | $12.00 – $280.00 | 14 |
| Vaccine pneumonococcal conjugate 15 valent (pcv15) im CPT 90671 | $44.38 | $634.00 | $134.30 – $760.80 | 13 |
| Vaccine pneumonococcal conjugate 20 valent (pcv20) im CPT 90677 | $56.62 | $808.92 | $44.00 – $379.55 | 14 |
| Vaccine polio (ipv) subcutaneous/im CPT 90713 | $7.56 | $108.00 | $12.00 – $61.78 | 14 |
| Vaccine rabies im CPT 90675 | $299.36 | $4,276.55 | $80.02 – $663.95 | 26 |
| Vaccine respiratory syncytial virus bivalent subunit/preservative free im CPT 90678 | $116.55 | $1,665.00 | $165.08 – $1,743.60 | 14 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 0.5 ml im CPT 90380 | $705.40 | $10,077.11 | $277.02 – $2,744.40 | 14 |
| Vaccine respiratory syncytial virus monoclonal antibody seasonal dose 1 ml im CPT 90381 | $160.09 | $2,287.00 | $307.82 – $2,744.40 | 13 |
| Vaccine respiratory syncytial virus recombinant subunit adjuvanted/preservative free im CPT 90679 | $43.75 | $625.00 | $174.12 – $750.00 | 13 |
| Vaccine rotavirus attenuated (rv1) live 2 dose oral CPT 90681 | $20.37 | $291.00 | $12.00 – $181.74 | 14 |
| Vaccine rotavirus pentavalent (rv5) live 3 dose oral CPT 90680 | $19.74 | $282.00 | $12.00 – $126.96 | 14 |
| Vaccine tdap >=7 years im CPT 90715 | $54.66 | $780.91 | $12.00 – $54.60 | 14 |
| Vaccine td preservative free >= 7 years im CPT 90714 | $19.62 | $280.26 | $11.17 – $100.03 | 14 |
| Vaccine typhoid vicps im CPT 90691 | $15.82 | $226.00 | $157.01 – $271.20 | 13 |
| Vaccine varicella live subcutaneous CPT 90716 | $44.20 | $631.44 | $12.00 – $237.54 | 14 |
| Vag hys/<250g/rmv tube/rpr entero 58263 CPT 58263 | $236.53 | $3,379.00 | $862.40 – $2,086.46 | 34 |
| Vag hyst incl t/o complex CPT 58291 | $294.07 | $4,201.00 | $656.68 – $2,654.78 | 34 |
| Vag hyst including t/o CPT 58262 | $220.78 | $3,154.00 | $40.00 – $1,936.49 | 34 |
| Vaginal bx CPT 58999 | $36.47 | $521.00 | $38.00 – $533.31 | 14 |
| Vaginal delivery after cesarean delivery 59612 CPT 59612 | $204.82 | $2,926.00 | $70.00 – $8,539.30 | 36 |
| Vaginal Delivery (full care) CPT 59400 | $565.11 | $8,073.00 | $40.00 – $3,631.02 | 33 |
| Vaginal hysterectomy CPT 58260 | $200.06 | $2,858.00 | $337.00 – $1,728.63 | 34 |
| Vagotomy & pylorus repair 43640 CPT 43640 | $278.74 | $3,982.00 | $143.34 – $2,014.43 | 34 |
| Valproate in ns IV syringe 10 mg/ml (pediatric) - cnr HCPCS J3379 | $15.61 | $222.98 | $0.04 – $318.63 | 7 |
| Valproic acid total therapeutic drug level CPT 80164 | $53.34 | $762.00 | $4.98 – $148.94 | 23 |
| Valvuloplasty/tv without ring insert 33463 CPT 33463 | $649.04 | $9,272.00 | $1,287.41 – $4,916.48 | 34 |
| Vancomycin 1,000 mg intravenous injection HCPCS J3373 | $47.48 | $678.23 | $0.04 – $5.69 | 10 |
| Vancomycin 750 mg intravenous solution HCPCS J3374 | $35.19 | $502.72 | $0.04 – $718.39 | 10 |
| Vancomycin peak therapeutic drug level CPT 80202 | $25.76 | $368.00 | $4.98 – $148.94 | 23 |
| Varicella zoster antibody igg CPT 86787 | $17.71 | $253.00 | $4.74 – $141.69 | 23 |
| Varicella-zoster immue globin im CPT 90396 | $29.96 | $428.00 | $66.74 – $6,434.32 | 22 |
| Vasc emb/occ w/prs cath HCPCS C9797 | $3,421.81 | $48,883.00 | $24,178.70 – $48,357.40 | 12 |
| Vasc graft into carpal bone CPT 25430 | $180.74 | $2,582.00 | $108.71 – $1,366.79 | 34 |
| Vasectomy CPT 55250 | $236.46 | $3,378.00 | $44.00 – $894.37 | 36 |
| Vasopressin 20 unit/ml intravenous solution HCPCS J2598 | $110.02 | $1,571.67 | $1.19 – $643.92 | 10 |
| Vbac delivery 59610 CPT 59610 | $586.88 | $8,384.00 | $1,390.14 – $3,631.02 | 33 |
| Vbac/include postpartum care 59614 CPT 59614 | $265.23 | $3,789.00 | $991.95 – $4,546.80 | 34 |
| Vedolizumab 300 mg intravenous solution HCPCS J3380 | $2,975.00 | $42,500.00 | $9.00 – $58.18 | 23 |
| Vein bypass grft fem-popliteal 35583 CPT 35583 | $319.62 | $4,566.00 | $224.50 – $2,649.27 | 36 |
| Vein byp fem-tibial peroneal 35585 CPT 35585 | $369.53 | $5,279.00 | $65.00 – $3,127.42 | 34 |
| Vein gft fem a/p tib/pero/dis art 35566 CPT 35566 | $367.29 | $5,247.00 | $223.38 – $3,070.23 | 36 |
| Vein x-ray eye socket CPT 75880 | $182.14 | $2,602.00 | $18.31 – $1,654.78 | 18 |
| Vein x-ray kidney CPT 75831 | $13.86 | $198.00 | $50.30 – $222.19 | 27 |
| Vein x-ray liver CPT 75891 | $14.14 | $202.00 | $51.04 – $222.67 | 27 |
| Vein x-ray liver w/hemodynam CPT 75889 | $14.00 | $200.00 | $50.67 – $222.19 | 27 |
| Vein x-ray skull CPT 75870 | $436.03 | $6,229.00 | $191.72 – $8,329.20 | 24 |
| Vein x-ray skull epidural CPT 75872 | $139.16 | $1,988.00 | $195.45 – $3,964.07 | 18 |
| Vein x-ray spleen/liver CPT 75810 | $541.80 | $7,740.00 | $255.64 – $24,205.46 | 24 |
| Venipuncture >= 3 years diagnostic/therapeutic (not to be used for routine venipuncture) CPT 36410 | $204.96 | $2,928.00 | $7.94 – $29.74 | 36 |
| Venogram ext bil s&i CPT 75822 | $868.84 | $12,412.00 | $59.50 – $4,152.50 | 37 |
| Venogram extremity supervision & interpretation unilateral CPT 75820 | $292.53 | $4,179.00 | $39.54 – $4,152.50 | 37 |
| Venous mech thrombectomy CPT 37187 | $4,437.72 | $63,396.00 | $65.00 – $30,452.80 | 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.