Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Lido 2% Epi 1:200000 20ML Vial
Milbank, SD
See all hospitals reporting HCPCS J2004 →Price type
Avera Milbank Hospital’s median price of $111 is 1583% above the median hospital's median price ($7), higher than 97% of the 1,679 hospitals reporting HCPCS J2004. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 4 payers, 11 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Medica com fee schedule · outpatient | $4.70 | $4.70 | $4.70 – $4.70 |
| 2 | Medica ind fee schedule · outpatient | $4.70 | $4.70 | $4.70 – $4.70 |
| 3 | Wellmark hmo outpatient | $25.40 | $25.40 | $25.40 – $25.40 |
| 4 | Wellmark ppo percent of total billed charges · inpatientfrom % of charges | $102.47 | $102.47 | $102.47 – $102.47 |
| 5 | Wellmark ppo percent of total billed charges · outpatientfrom % of charges | $102.47 | $102.47 | $102.47 – $102.47 |
| 6 | Medica ind percent of total billed charges · inpatientfrom % of charges | $118.94 | $118.94 | $118.94 – $118.94 |
| 7 | Medica com percent of total billed charges · inpatientfrom % of charges | $141.27 | $141.27 | $141.27 – $141.27 |
| 8 | UnitedHealthcare com percent of total billed charges · inpatientfrom % of charges | $156.09 | $156.09 | $156.09 – $156.09 |
| 9 | UnitedHealthcare com percent of total billed charges · outpatientfrom % of charges | $156.09 | $156.09 | $156.09 – $156.09 |
| 10 | Healthpartners com percent of total billed charges · inpatientfrom % of charges | $173.84 | $173.84 | $173.84 – $173.84 |
| 11 | Healthpartners com percent of total billed charges · outpatientfrom % of charges | $173.84 | $173.84 | $173.84 – $173.84 |
Last updated: Apr 1, 2026
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