Supplies, drugs & other prices at Adventist Health Lodi Memorial
Lodi, CA · every code in this section with a posted price and a Medicare benchmark.
179 codes. Prices are the hospital's own posted facility charges.
Compare against other hospitals interactively →
| Procedure | Posted cash | Posted gross | × Medicare |
|---|---|---|---|
| 2d tte w or w/o fol w/con,fu (C8924) range across 2 matching MRF lines |
$6.72–$6.93 | $96–$99 | varies |
| Adm of soc dtr assess 5-15 m (G0136) | $3.43 | $49 | 0.1× |
| Admin hepatitis b vaccine (G0010) | $4.34 | $62 | 0.1× |
| Alveoloplasty not w/extracts (D7321) | $25.06 | $358 | 0.0× |
| Alveoplasty w/ extraction (D7310) | $34.30 | $490 | 0.0× |
| Alveoplasty w/o extraction (D7320) | $64.19 | $917 | 0.0× |
| Amalgam 4 or > surfaces perm (D2161) | $37.80 | $540 | 0.0× |
| Amalgam one surface permanen (D2140) | $15.75 | $225 | 0.0× |
| Amalgam three surfaces perma (D2160) | $25.48 | $364 | 0.0× |
| Amalgam two surfaces permane (D2150) | $18.90 | $270 | 0.0× |
| Annual alcohol screen 15 min (G0442) range across 3 matching MRF lines |
$1.40–$3.15 | $20–$45 | varies |
| Ant resin-based cmpst crown (D2390) | $33.88 | $484 | 0.0× |
| Apicoectomy - anterior (D3410) | $93.80 | $1,340 | 0.1× |
| Ascvd rsk mng clin stf pr mo (G0538) | $2.80 | $40 | 0.0× |
| Behavior counsel obesity 15m (G0447) range across 2 matching MRF lines |
$5.67–$6.86 | $81–$98 | varies |
| Bitewings four images (D0274) | $9.10 | $130 | 0.0× |
| Brief alcohol misuse counsel (G0443) range across 3 matching MRF lines |
$4.13–$5.67 | $59–$81 | varies |
| Brief chkin by md/qhp, 11-20 (G2252) range across 2 matching MRF lines |
$4.34–$4.55 | $62–$65 | varies |
| Brief chkin, 5-10, non-e/m (G2251) range across 2 matching MRF lines |
$2.17–$2.52 | $31–$36 | varies |
| Ca screen;flexi sigmoidscope (G0104) | $9.80 | $140 | 0.0× |
| Ca screen;pelvic/breast exam (G0101) range across 4 matching MRF lines |
$4.62–$9.10 | $66–$130 | varies |
| Catheterize for urine spec (P9612) | $2.17 | $31 | 0.2× |
| Colon ca scrn not hi rsk ind (G0121) | $31.15 | $445 | 0.0× |
| Colorectal scrn; hi risk ind (G0105) range across 2 matching MRF lines |
$31.15–$31.92 | $445–$456 | varies |
| Complete occlusal adjustment (D9952) | $75.25 | $1,075 | 0.1× |
| Comprehensve oral evaluation (D0150) | $9.87 | $141 | 0.1× |
| Core build-up incl any pins (D2950) | $34.93 | $499 | 0.0× |
| Crown 3/4 cast base metal (D2781) | $71.40 | $1,020 | 0.1× |
| Crown 3/4 porcelain/ceramic (D2783) | $71.40 | $1,020 | 0.1× |
| Crown 3/4 resin-based compos (D2712) | $31.50 | $450 | 0.0× |
| Crown full cast base metal (D2791) | $115.01 | $1,643 | 0.1× |
| Crown full cast noble metal (D2792) | $116.69 | $1,667 | 0.1× |
| Crown lengthen hard tissue (D4249) | $100.45 | $1,435 | 0.1× |
| Crown porcelain fused base m (D2751) | $115.01 | $1,643 | 0.1× |
| Crown porcelain w/ h noble m (D2750) | $139.02 | $1,986 | 0.2× |
| Crown porcelain w/ noble met (D2752) | $120.19 | $1,717 | 0.1× |
| Crown porcelain/ceramic (D2740) | $127.40 | $1,820 | 0.1× |
| Crown resin w/ base metal (D2721) | $51.31 | $733 | 0.1× |
| Crown resin-based indirect (D2710) | $31.50 | $450 | 0.0× |
| Dental bitewing single image (D0270) | $6.30 | $90 | 0.1× |
| Dental bitewings two images (D0272) | $6.30 | $90 | 0.1× |
| Dental prophylaxis adult (D1110) | $12.32 | $176 | 0.1× |
| Dental tomographic survey (D0322) | $31.43 | $449 | 0.2× |
| Dental unspec restorative pr (D2999) | $42.07 | $601 | 0.0× |
| Depression screen annual (G0444) range across 3 matching MRF lines |
$1.40–$3.15 | $20–$45 | varies |
| Diab manage trn per indiv (G0108) range across 2 matching MRF lines |
$9.59–$11.83 | $137–$169 | varies |
| Diab manage trn ind/group (G0109) range across 2 matching MRF lines |
$2.80–$4.13 | $40–$59 | varies |
| Direct refer hospital observ (G0379) | $57.05 | $815 | 0.1× |
| Each addtnl prefab post (D2957) | $17.85 | $255 | 0.0× |
| Elec stim other than wound (G0283) | $5.46 | $78 | 0.4× |
| End thxpy, anterior tooth (D3310) | $82.32 | $1,176 | 0.1× |
| End thxpy, molar tooth (D3330) | $130.55 | $1,865 | 0.2× |
| End thxpy, premolar tooth (D3320) | $100.80 | $1,440 | 0.1× |
| Endodontic procedure (D3999) | $42.07 | $601 | 0.0× |
| Excision benign lesion>1.25c (D7411) | $59.43 | $849 | 0.0× |
| Exposure of unerupted tooth (D7280) | $40.04 | $572 | 0.0× |
| Extensv oral eval prob focus (D0160) | $14.56 | $208 | 0.1× |
| Extraction coronal remnants (D7111) | $10.08 | $144 | 0.0× |
| Extraction erupted tooth/exr (D7140) | $15.05 | $215 | 0.0× |
| Fecal blood scrn immunoassay (G0328) range across 3 matching MRF lines |
$1.11–$18.76 | $15.92–$268 | varies |
| Followup eval of foot pt lop (G0246) range across 2 matching MRF lines |
$3.36–$6.93 | $48–$99 | varies |
| Full mouth debridement (D4355) | $20.44 | $292 | 0.0× |
| Gingival flap proc w/ planin (D4240) | $88.20 | $1,260 | 0.0× |
| Gingivectomy/plasty 1 to 3 (D4211) | $42.77 | $611 | 0.0× |
| Gingivectomy/plasty 4 or mor (D4210) | $54.67 | $781 | 0.0× |
| Gngvl flap w rootplan 1-3 th (D4241) | $50.96 | $728 | 0.0× |
| Gross pulpal debridement (D3221) | $21.42 | $306 | 0.0× |
| Hep c screen high risk/other (G0472) | $8.12 | $116 | 0.2× |
| High inten beh couns std 30m (G0445) range across 2 matching MRF lines |
$5.11–$5.60 | $73–$80 | varies |
| I&d absc intraoral soft tiss (D7510) | $27.51 | $393 | 0.0× |
| I&d abscess extraoral (D7520) | $124.32 | $1,776 | 0.1× |
| Impact tooth rem bony w/comp (D7241) | $57.68 | $824 | 0.1× |
| Impact tooth remov comp bony (D7240) | $56.21 | $803 | 0.1× |
| Impact tooth remov part bony (D7230) | $48.02 | $686 | 0.1× |
| Impact tooth remov soft tiss (D7220) | $35.49 | $507 | 0.0× |
| Initial foot exam pt lops (G0245) range across 2 matching MRF lines |
$6.72–$11.34 | $96–$162 | varies |
| Initial preventive exam (G0402) range across 3 matching MRF lines |
$22.40–$29.12 | $320–$416 | varies |
| Intens behave ther cardio dx (G0446) range across 3 matching MRF lines |
$4.13–$5.67 | $59–$81 | varies |
| Intens cardiac rehab no exer (G0423) | $59.15 | $845 | 0.3× |
| Intens cardiac rehab w/exerc (G0422) | $59.15 | $845 | 0.3× |
| Intentional replantation (D3470) | $44.80 | $640 | 0.1× |
| Intraor comprehensive series (D0210) | $14.77 | $211 | 0.0× |
| Intraoral occlusal film (D0240) | $6.16 | $88 | 0.1× |
| Intraoral periapical first (D0220) | $3.85 | $55 | 0.0× |
| Labial veneer resin direct (D2960) | $86.73 | $1,239 | 0.1× |
| Limit oral eval problm focus (D0140) | $9.66 | $138 | 0.1× |
| Limited occlusal adjustment (D9951) | $14.35 | $205 | 0.0× |
| Mesial/distal wedge proc (D4274) | $65.73 | $939 | 0.1× |
| Mra w/cont, lwr ext (C8912) | $267.89 | $3,827 | 0.6× |
| Mra w/cont, pelvis (C8918) | $267.89 | $3,827 | 0.6× |
| Neuro csf prion prtn qual (0035U) range across 2 matching MRF lines |
$33.03–$37.87 | $471.87–$540.99 | varies |
| Njx bone sub matrl into subchondral bone defect (0707T) | $94.50 | $1,350 | 0.0× |
| Njx platelet plasma (0232T) range across 2 matching MRF lines |
$83.23–$237.16 | $1,189–$3,388 | varies |
| Obtaining screen pap smear (Q0091) range across 4 matching MRF lines |
$3.15–$8.05 | $45–$115 | varies |
| Occ guard, hard, full arch (D9944) | $26.25 | $375 | 0.0× |
| Occ guard, soft, full arch (D9945) | $26.25 | $375 | 0.0× |
| Occlusion analysis (D9950) | $25.20 | $360 | 0.0× |
| Onc Merkel Cll Carc Srm Quan (0058U) | $23.90 | $341.38 | 0.1× |
| Oral antral fistula closure (D7260) | $75.04 | $1,072 | 0.1× |
| Osseous surg 1 to 3 teeth (D4261) | $77.98 | $1,114 | 0.0× |
| Osseous surgery 4 or more (D4260) likely a partial charge, not the full procedure |
$145.18 | $2,074 | 0.0× |
| Oth resp proc, group (G0239) | $12.53 | $179 | 0.3× |
| Oth resp proc, indiv (G0238) | $12.53 | $179 | 0.3× |
| Panoramic image (D0330) | $14.63 | $209 | 0.0× |
| Perc d-e cor revasc chro sin (C9607) likely a partial charge, not the full procedure |
$102.20 | $1,460 | 0.0× |
| Perc d-e cor revasc t cabg s (C9604) range across 2 matching MRF lines likely a partial charge, not the full procedure |
$2,425.01 | $750–$34,643 | 0.2× |
| Perc d-e cor stent ather s (C9602) likely a partial charge, not the full procedure |
$83.23 | $1,189 | 0.0× |
| Perc drug-el cor stent sing (C9600) range across 3 matching MRF lines |
$2,813.79–$3,511.34 | $1,240–$50,162 | varies |
| Periodic oral evaluation (D0120) | $6.65 | $95 | 0.0× |
| Periodontal maint procedures (D4910) | $15.33 | $219 | 0.0× |
| Periodontal scaling & root (D4341) | $31.71 | $453 | 0.0× |
| Periodontal scaling 1-3teeth (D4342) | $22.47 | $321 | 0.0× |
| Perq tcat ther rx dlvr ntrac rx balo 1 maj c art (0913T) likely a partial charge, not the full procedure |
$1,316.35 | $18,805 | 0.1× |
| Place device/marker, non pro (C9728) | $261.38 | $3,734 | 0.1× |
| Place direct restoration (D2940) | $15.40 | $220 | 0.0× |
| Post 1 srfc resinbased cmpst (D2391) | $26.25 | $375 | 0.0× |
| Post 2 srfc resinbased cmpst (D2392) | $24.08 | $344 | 0.0× |
| Post 3 srfc resinbased cmpst (D2393) | $29.96 | $428 | 0.0× |
| Post >=4srfc resinbase cmpst (D2394) | $29.75 | $425 | 0.0× |
| Post and core cast + crown (D2952) | $116.83 | $1,669 | 0.1× |
| Ppps, initial visit (G0438) range across 2 matching MRF lines |
$29.05–$29.89 | $415–$427 | varies |
| Ppps, subseq visit (G0439) range across 2 matching MRF lines |
$22.96–$23.59 | $328–$337 | varies |
| Prefab post/core + crown (D2954) | $35.35 | $505 | 0.0× |
| Prefab stnlss steel crown pe (D2931) | $42.14 | $602 | 0.0× |
| Prefab stnlss steel crwn pri (D2930) | $29.61 | $423 | 0.0× |
| Psa screening (G0103) range across 9 matching MRF lines |
$1.29–$48.86 | $12.70–$698 | varies |
| Pulp cap direct (D3110) | $15.40 | $220 | 0.0× |
| Pulp cap indirect (D3120) | $14.63 | $209 | 0.0× |
| Pulp vitality test (D0460) | $3.71 | $53 | 0.0× |
| Pulpal therapy anterior prim (D3230) | $21.07 | $301 | 0.0× |
| Pulpal therapy posterior pri (D3240) | $23.10 | $330 | 0.0× |
| Rad exc lesion up to 1.25 cm (D7410) | $37.59 | $537 | 0.0× |
| Rbc DNA hea 35 ag 11 bld grp whl bld cmn allel (0001U) | $16.80 | $240 | 0.0× |
| Re-cement or re-bond crown (D2920) | $14.63 | $209 | 0.0× |
| Re-eval,est pt,problem focus (D0170) | $9.59 | $137 | 0.1× |
| Recement inlay onlay or part (D2910) | $7 | $100 | 0.0× |
| Rem exostosis any site (D7471) | $90.16 | $1,288 | 0.0× |
| Rem imp tooth w mucoper flp (D7210) | $26.04 | $372 | 0.0× |
| Rem nonodonto cyst > 1.25 cm (D7461) | $50.61 | $723 | 0.1× |
| Rem nonodonto cyst to 1.25cm (D7460) | $37.59 | $537 | 0.0× |
| Removal of sloughed off bone (D7550) | $26.46 | $378 | 0.0× |
| Remove torus mandibularis (D7473) | $101.15 | $1,445 | 0.1× |
| Resin 4/> surf or w incis an (D2335) | $28.07 | $401 | 0.0× |
| Resin one surface-anterior (D2330) | $26.25 | $375 | 0.0× |
| Resin three surfaces-anterio (D2332) | $35.70 | $510 | 0.0× |
| Resin two surfaces-anterior (D2331) | $32.90 | $470 | 0.0× |
| Retreat root canal anterior (D3346) | $109.76 | $1,568 | 0.1× |
| Retreat root canal molar (D3348) | $159.81 | $2,283 | 0.2× |
| Retreat root canal premolar (D3347) | $129.15 | $1,845 | 0.2× |
| Retrograde filling (D3430) | $28.70 | $410 | 0.0× |
| Revasc intra lithotrip-ather (C9766) likely a partial charge, not the full procedure |
$4,130.28 | $59,004 | 0.2× |
| Revasc intra lithotrip-stent (C9765) likely a partial charge, not the full procedure |
$3,114.16 | $44,488 | 0.1× |
| Revasc intravasc lithotripsy (C9764) unusually low: confirm this is the full procedure |
$4,690.70 | $67,010 | 0.3× |
| Revasc lith-sten-ath tib/per (C9775) likely a partial charge, not the full procedure |
$2,957.85 | $42,255 | 0.1× |
| Revasc lithotr-ather tib/per (C9774) likely a partial charge, not the full procedure |
$2,781.94 | $39,742 | 0.1× |
| Revasc lithotr-stent tib/per (C9773) likely a partial charge, not the full procedure |
$3,423.98 | $48,914 | 0.1× |
| Revasc lithotrip tibi/perone (C9772) unusually low: confirm this is the full procedure |
$4,690.70 | $67,010 | 0.3× |
| Revasc lithotrip-stent-ather (C9767) likely a partial charge, not the full procedure |
$3,598.91 | $51,413 | 0.1× |
| Risk ascvd tst once pr 12 mo (G0537) | $3.43 | $49 | 0.1× |
| Root surgery molar (D3425) | $98.21 | $1,403 | 0.1× |
| Routine footcare pt w lops (G0247) | $15.12 | $216 | 0.1× |
| Space maintainer fxd unilat (D1510) | $37.66 | $538 | 0.0× |
| Surg reduct osseoustuberosit (D7485) likely a partial charge, not the full procedure |
$46.48 | $664 | 0.0× |
| Surgical splint (D5988) | $36.40 | $520 | 0.0× |
| Therapeutic procd strg endur (G0237) | $12.53 | $179 | 0.3× |
| Therapeutic pulpotomy (D3220) | $19.53 | $279 | 0.0× |
| Tomosynthesis, mammo (G0279) | $4.90 | $70 | 0.4× |
| Tooth pin retention (D2951) | $6.37 | $91 | 0.0× |
| Tooth reimplantation (D7270) | $23.52 | $336 | 0.0× |
| Tooth root removal (D7250) | $30.38 | $434 | 0.0× |
| Treatment of complications (D9930) | $5.88 | $84 | 0.0× |
| Trim nail(s) (G0127) range across 2 matching MRF lines |
$3.64–$53.48 | $52–$764 | varies |
| Trluml Perip Athrc Brchiocph (0237T) likely a partial charge, not the full procedure |
$2,800.98 | $40,014 | 0.2× |
| Tte w or wo fol wcon,doppler (C8929) | $18.76 | $268 | 0.0× |
| Unsched dialysis esrd pt hos (G0257) | $255.78 | $3,654 | 0.3× |
| Vasc emb/occ w/prs cath (C9797) likely a partial charge, not the full procedure |
$3,421.81 | $48,883 | 0.1× |
| Vestibuloplasty ridge extens (D7340) likely a partial charge, not the full procedure |
$86.03 | $1,229 | 0.0× |
| Visit to determ ldct elig (G0296) range across 2 matching MRF lines |
$4.34–$7.77 | $62–$111 | varies |
| Wet mounts/ w preparations (Q0111) | $3.15 | $45 | 0.2× |
A range means this hospital published different amounts on matching machine-readable-file lines. We show the lowest–highest posted amount because we cannot tell from the published file which line would apply to a particular visit.