CMS Price Transparency Data

Review of medical records for care

Facility: Adventist Health Lodi Memorial

Billing Code: 90889 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 90889
Insurance Median: $116
Cash Discount Price: $9
vs. Medicare Baseline: N/A Medicare

The contracted insurance negotiated median rate for a Review of medical records for care at Adventist Health Lodi Memorial is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $9. Compared to the federal Medicare reimbursement reference rate of N/A, this hospital’s rate is N/A the Medicare baseline. Located in 975 S Fairmont Avenue, Lodi, CA.

Cash / Self-Pay

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

N/A

Standard federal government reimbursement rate for this code.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Networks By Design- All Plans	$74	N/A
Cigna	$78	N/A
Ah Employee Health Plan - All Plans	$86	N/A
Aetna	$93	N/A
UnitedHealthcare	$93	N/A
Western Growers- All Plans	$98	N/A
Multiplan- All Plans	$105	N/A
Healthnet- All Other Plans	$109	N/A
Bc Mcal	$123	N/A
Celtic Ins Company - All Plans	$123	N/A
Kaiser Mcal	$123	N/A
Medi-Cal	$123	N/A
Hp Mcal Pro Fee	$135	N/A
Healthnet Mcal	$148	N/A
Hp Of San Joaquin Mcal	$148	N/A
Blue Shield Epn - All Other Plans	$152	N/A
Blue Cross Blue Shield	$156	N/A
Blue Shield Non-Epn	$161	N/A

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $9.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 90889.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Lodi Memorial is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 90889.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.