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 |
|---|---|---|---|---|
| Whole mitochondrial genome CPT 81460 | $12.74 | $182.00 | $182.00 – $22,668.84 | 22 |
| Wnd prep f/n/hf/g addl cm CPT 15005 | $20.79 | $297.00 | $20.00 – $186.82 | 36 |
| Wound closure by adhesive HCPCS G0168 | $2.38 | $34.00 | $0.98 – $149.14 | 32 |
| Wound therapy negative pressure per session <= 50 sq cm CPT 97607 | $65.24 | $932.00 | $18.32 – $1,072.36 | 35 |
| Wound therapy negative pressure per session > 50 sq cm CPT 97608 | $4.06 | $58.00 | $21.11 – $1,072.36 | 35 |
| Wound therapy negative pressure per session <= 50 sq cm dme CPT 97605 | $63.28 | $904.00 | $21.45 – $304.00 | 36 |
| Wound therapy negative pressure per session > 50 sq cm dme CPT 97606 | $64.96 | $928.00 | $23.52 – $304.00 | 36 |
| Wrist arthroscopy CPT 29840 | $113.47 | $1,621.00 | $80.00 – $873.23 | 34 |
| Wrist arthroscopy/surgery CPT 29844 | $124.53 | $1,779.00 | $374.91 – $984.75 | 34 |
| Wrist arthroscopy/surgery CPT 29846 | $129.78 | $1,854.00 | $492.97 – $1,032.21 | 34 |
| Wrist endoscopy/surgery CPT 29848 | $192.29 | $2,747.00 | $250.56 – $951.53 | 34 |
| Wrist X-ray CPT 73110 | $148.47 | $2,121.00 | $8.88 – $229.57 | 37 |
| Xcapsl ctrc rmvl cplx wo ecp CPT 66982 | $181.58 | $2,594.00 | $120.00 – $1,920.00 | 34 |
| Xcapsl ctrc rmvl insj 1+ CPT 66991 | $167.09 | $2,387.00 | $74.00 – $1,065.09 | 33 |
| Xe133 xenon 10mci HCPCS A9558 | $55.79 | $797.00 | $14.81 – $1,138.91 | 10 |
| Xfer tis f/c/c/m/n/a/g/h/f 10sq cm/< CPT 14040 | $189.35 | $2,705.00 | $152.00 – $1,096.58 | 36 |
| Xfer tis s/a/l 10 sq cm/< CPT 14020 | $175.63 | $2,509.00 | $52.00 – $1,039.72 | 36 |
| Xpos opn fmrl eprst aor uni add-on CPT 34812 | $45.15 | $645.00 | $76.00 – $652.02 | 36 |
| X-ray abdomen 1 view CPT 74018 | $85.89 | $1,227.00 | $8.86 – $229.57 | 37 |
| X-ray abdomen 2 views CPT 74019 | $115.22 | $1,646.00 | $10.95 – $275.78 | 37 |
| X-ray abdomen >=3 views CPT 74021 | $129.50 | $1,850.00 | $12.67 – $275.78 | 37 |
| X-ray abdomen complete acute series including spine erect and/or decubitus single view chest CPT 74022 | $115.50 | $1,650.00 | $15.28 – $275.78 | 37 |
| X-ray acromioclavicular joints without or w/weighted distraction bilateral CPT 73050 | $95.48 | $1,364.00 | $9.59 – $229.57 | 37 |
| X-ray ankle 2 views (both sides) CPT 73600 | $118.86 | $1,698.00 | $8.18 – $229.57 | 37 |
| X-ray arthrogram shoulder supervision & interpretation (both sides) CPT 73040 | $202.58 | $2,894.00 | $27.33 – $920.30 | 37 |
| X-ray assay calculus CPT 82370 | $0.88 | $12.52 | $4.76 – $137.76 | 23 |
| X-ray bone age studies CPT 77072 | $106.75 | $1,525.00 | $9.20 – $275.78 | 37 |
| X-ray bone length studies CPT 77073 | $128.80 | $1,840.00 | $13.24 – $275.78 | 37 |
| X-ray bone survey complete CPT 77075 | $275.10 | $3,930.00 | $26.20 – $408.54 | 37 |
| X-ray bone survey infant CPT 77076 | $91.35 | $1,305.00 | $30.65 – $275.78 | 37 |
| X-ray cervical spine 2-3 views CPT 72040 | $147.84 | $2,112.00 | $10.61 – $229.57 | 37 |
| X-ray cervical spine 4-5 views CPT 72050 | $194.39 | $2,777.00 | $13.22 – $275.78 | 37 |
| X-ray cervical spine >= 6 views CPT 72052 | $214.76 | $3,068.00 | $14.60 – $320.53 | 37 |
| X-ray clavicle complete (both sides) CPT 73000 | $111.72 | $1,596.00 | $8.18 – $229.57 | 37 |
| X-ray colon abdominal radiograph(s) & delayed images single contrast study CPT 74270 | $212.31 | $3,033.00 | $39.93 – $469.10 | 37 |
| X-ray colon abdominal radiograph(s) & delayed images with glucagon double contrast study CPT 74280 | $250.25 | $3,575.00 | $49.65 – $547.38 | 37 |
| X-ray elbow 2 views (both sides) CPT 73070 | $115.29 | $1,647.00 | $8.18 – $229.57 | 37 |
| X-ray elbow >= 3 views (both sides) CPT 73080 | $152.39 | $2,177.00 | $8.52 – $229.57 | 37 |
| X-ray esophogram chest radiograph(s) & delayed images single contrast study CPT 74220 | $185.78 | $2,654.00 | $26.56 – $462.69 | 37 |
| X-ray exam entire spi 4/5 vw CPT 72083 | $87.01 | $1,243.00 | $8.88 – $547.78 | 37 |
| X-ray exam entire spi 6/> vw CPT 72084 | $5.53 | $79.00 | $10.13 – $85.24 | 34 |
| X-ray exam of arm infant CPT 73092 | $123.48 | $1,764.00 | $7.81 – $275.78 | 37 |
| X-ray exam of eye sockets CPT 70200 | $108.64 | $1,552.00 | $13.38 – $275.78 | 37 |
| X-ray exam of femur 1 CPT 73551 | $212.10 | $3,030.00 | $4.95 – $229.57 | 37 |
| X-ray exam of jaw joint CPT 70328 | $19.25 | $275.00 | $8.86 – $229.57 | 37 |
| X-ray exam of mastoids CPT 70120 | $99.82 | $1,426.00 | $8.86 – $275.78 | 37 |
| X-ray exam of salivary gland CPT 70380 | $74.90 | $1,070.00 | $8.15 – $229.57 | 37 |
| X-ray exam of sinuses CPT 70210 | $85.26 | $1,218.00 | $8.52 – $229.57 | 37 |
| X-ray exam si joints CPT 72200 | $65.87 | $941.00 | $8.52 – $275.78 | 37 |
| X-ray exam thorac spine4/>vw CPT 72074 | $191.66 | $2,738.00 | $11.63 – $275.78 | 37 |
| X-ray eye detection foreign body (both sides) CPT 70030 | $2.38 | $34.00 | $8.86 – $29.62 | 34 |
| X-ray facial bones complete > 3 views CPT 70150 | $124.67 | $1,781.00 | $12.70 – $275.78 | 37 |
| X-ray femur >=2 views (both sides) CPT 73552 | $215.25 | $3,075.00 | $5.58 – $249.17 | 37 |
| X-ray finger(s) >= 2 views (both sides) CPT 73140 | $81.13 | $1,159.00 | $6.79 – $229.57 | 37 |
| X-ray foot 2 views (both sides) CPT 73620 | $113.61 | $1,623.00 | $7.81 – $229.57 | 37 |
| X-ray forearm 2 views (both sides) CPT 73090 | $145.53 | $2,079.00 | $7.81 – $229.57 | 37 |
| X-ray hand 2 views (both sides) CPT 73120 | $113.61 | $1,623.00 | $8.18 – $275.78 | 37 |
| X-ray heel/calcaneus > 2 views (both sides) CPT 73650 | $129.50 | $1,850.00 | $7.81 – $229.57 | 37 |
| X-ray hip uni w/wo pelvis min 4 views CPT 73503 | $131.74 | $1,882.00 | $8.25 – $405.67 | 37 |
| X-ray hip with pelvis when performed bilateral 2 views CPT 73521 | $119.42 | $1,706.00 | $7.02 – $307.60 | 37 |
| X-ray hip with pelvis when performed bilateral 3-4 views CPT 73522 | $78.40 | $1,120.00 | $8.52 – $366.97 | 37 |
| X-ray hip with pelvis when performed bilateral >= 5 views CPT 73523 | $4.13 | $59.00 | $9.01 – $441.65 | 37 |
| X-ray hip with pelvis when performed unilateral 1 view left CPT 73501 | $81.76 | $1,168.00 | $5.79 – $229.57 | 37 |
| X-ray humerus >= 2 views left CPT 73060 | $143.29 | $2,047.00 | $8.18 – $229.57 | 37 |
| X-ray joint survey 1 view CPT 77077 | $4.55 | $65.00 | $16.72 – $39.88 | 34 |
| X-ray knee 1-2 views (both sides) CPT 73560 | $112.07 | $1,601.00 | $8.18 – $229.57 | 37 |
| X-ray knee 3 views (both sides) CPT 73562 | $148.19 | $2,117.00 | $9.59 – $229.57 | 37 |
| X-ray knee ap standing bilateral CPT 73565 | $94.50 | $1,350.00 | $8.54 – $229.57 | 37 |
| X-ray lower extremities infant > 2 views (both sides) CPT 73592 | $123.48 | $1,764.00 | $7.81 – $229.57 | 37 |
| X-ray l/s-spine bend vw only 2-3 vw CPT 72120 | $214.76 | $3,068.00 | $10.97 – $275.78 | 37 |
| X-ray lumbosacral spine >= 4 views CPT 72110 | $194.39 | $2,777.00 | $12.88 – $275.78 | 37 |
| X-ray lumbosacral spine complete including bending views >= 6 views CPT 72114 | $214.76 | $3,068.00 | $14.60 – $335.05 | 37 |
| X-ray mandible complete > 4 views CPT 70110 | $127.12 | $1,816.00 | $11.99 – $275.78 | 37 |
| X-ray mandible ltd <4 views CPT 70100 | $106.47 | $1,521.00 | $9.22 – $229.57 | 37 |
| X-ray nasal bones complete > 3 views CPT 70160 | $112.56 | $1,608.00 | $8.52 – $229.57 | 37 |
| X-ray neck soft tissue CPT 70360 | $81.76 | $1,168.00 | $8.86 – $229.57 | 37 |
| X-ray nose to rectum for foreign body child CPT 76010 | $92.75 | $1,325.00 | $8.49 – $229.57 | 37 |
| X-ray of mammary ducts CPT 77054 | $5.81 | $83.00 | $21.34 – $100.10 | 34 |
| X-ray optic foramina CPT 70190 | $82.67 | $1,181.00 | $10.63 – $229.57 | 37 |
| X-ray pelvis 1-2 views CPT 72170 | $91.70 | $1,310.00 | $8.52 – $275.78 | 37 |
| X-ray pelvis complete > 3 views CPT 72190 | $96.25 | $1,375.00 | $12.54 – $275.78 | 37 |
| X-ray retrograde pyelogram with or without kidney ureter bladder w/supervision & interpretation CPT 74420 | $6.79 | $97.00 | $20.33 – $254.67 | 34 |
| X-ray ribs 2 views left CPT 71100 | $107.10 | $1,530.00 | $10.61 – $229.57 | 37 |
| X-ray ribs 3 views bilateral CPT 71110 | $128.45 | $1,835.00 | $13.72 – $275.78 | 37 |
| X-ray ribs w/posterior anterior chest 3 views left CPT 71101 | $117.95 | $1,685.00 | $12.85 – $275.78 | 37 |
| X-ray ribs w/posterior anterior chest > 4 views bilateral CPT 71111 | $114.52 | $1,636.00 | $15.28 – $275.78 | 37 |
| X-ray sacroiliac joints >= 3 views CPT 72202 | $105.91 | $1,513.00 | $10.58 – $275.78 | 37 |
| X-ray sacrum/coccyx >= 2 views CPT 72220 | $96.18 | $1,374.00 | $8.52 – $229.57 | 37 |
| X-ray scapula complete (both sides) CPT 73010 | $143.22 | $2,046.00 | $9.25 – $275.78 | 37 |
| X-ray sella turcica CPT 70240 | $2.52 | $36.00 | $9.20 – $29.21 | 34 |
| X-ray shoulder 1 view (both sides) CPT 73020 | $74.27 | $1,061.00 | $7.47 – $229.57 | 37 |
| X-ray sinuses paranasal complete > 3 views CPT 70220 | $124.95 | $1,785.00 | $10.61 – $229.57 | 37 |
| X-ray sinus tract/fistula/abscess CPT 76080 | $143.85 | $2,055.00 | $24.21 – $1,441.40 | 37 |
| X-ray skull < 4 views CPT 70250 | $95.69 | $1,367.00 | $8.86 – $275.78 | 37 |
| X-ray skull > 4 views complete CPT 70260 | $156.31 | $2,233.00 | $13.38 – $275.78 | 37 |
| X-ray slg plne bdy sect without urogr CPT 76100 | $7.56 | $108.00 | $27.59 – $109.45 | 34 |
| X-ray small bowel multi serial images abdominal radiographs(s)&delayed images single contrast study CPT 74250 | $153.23 | $2,189.00 | $27.39 – $462.69 | 37 |
| X-ray small intestine follow-through study CPT 74248 | $116.06 | $1,658.00 | $32.60 – $342.71 | 37 |
| X-ray spine single view CPT 72020 | $63.70 | $910.00 | $7.81 – $229.57 | 37 |
| X-ray sternoclavicular joint(s) > 3 views CPT 71130 | $95.13 | $1,359.00 | $10.61 – $229.57 | 37 |
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.