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
lidocaine 1 %-epinephrine 1:100,000 injection solution
Grapevine, TX
See all hospitals reporting HCPCS J2004 →Price type
Baylor Scott & White Medical Center - Grapevine’s median price of $10 is 52% above the median hospital's median price ($7), higher than 55% 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: 9 payers, 23 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 | Superior Healthplan medicaid facility · percent of total billed charges · outpatientfrom % of charges | $3.12 | $3.91 | $0.07 – $12.15 |
| 2 | Aetna medicaid facility · percent of total billed charges · outpatientfrom % of charges | $3.19 | $3.99 | $0.07 – $12.39 |
| 3 | UnitedHealthcare medicaid/chip facility · percent of total billed charges · outpatientfrom % of charges | $3.34 | $4.18 | $0.07 – $13.00 |
| 4 | Blue Cross Blue Shield blue advantage facility · percent of total billed charges · outpatientfrom % of charges | $7.29 | $9.13 | $0.16 – $28.35 |
| 5 | Cigna local plus facility · percent of total billed charges · outpatientfrom % of charges | $10.26 | $12.85 | $0.23 – $39.93 |
| 6 | Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges | $11.45 | $14.34 | $0.25 – $44.55 |
| 7 | Cigna hmo/ppo facility · percent of total billed charges · outpatientfrom % of charges | $12.08 | $15.12 | $0.27 – $46.98 |
| 8 | Baylor Scott White Health Plan bsw premier - large group/bsw premier direct to employer (rate 1)/bswh employee facility · percent of total billed charges · inpatientfrom % of charges | $12.39 | $15.51 | $0.27 – $48.20 |
| 9 | Baylor Scott White Health Plan bsw premier - large group/bsw premier direct to employer (rate 1)/bswh employee facility · percent of total billed charges · outpatientfrom % of charges | $12.39 | $15.51 | $0.27 – $48.20 |
| 10 | Aetna medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $12.49 | $15.64 | $0.28 – $48.60 |
| 11 | UnitedHealthcare charter facility · percent of total billed charges · outpatientfrom % of charges | $12.95 | $16.22 | $0.29 – $50.37 |
| 12 | UnitedHealthcare nexus facility · percent of total billed charges · outpatientfrom % of charges | $12.95 | $16.22 | $0.29 – $50.37 |
| 13 | Ambetter ambetter exchange facility · percent of total billed charges · outpatientfrom % of charges | $13.53 | $16.95 | $0.30 – $52.65 |
| 14 | Blue Cross Blue Shield city of dallas facility · percent of total billed charges · outpatientfrom % of charges | $13.95 | $17.47 | $0.31 – $54.27 |
| 15 | UnitedHealthcare commercial broad facility · percent of total billed charges · outpatientfrom % of charges | $14.39 | $18.02 | $0.32 – $55.97 |
| 16 | Baylor Scott White Health Plan bsw plus - large group/bsw premier direct to employer (rate 2) facility · percent of total billed charges · inpatientfrom % of charges | $14.57 | $18.25 | $0.32 – $56.70 |
| 17 | Baylor Scott White Health Plan bsw plus - large group/bsw premier direct to employer (rate 2) facility · percent of total billed charges · outpatientfrom % of charges | $14.57 | $18.25 | $0.32 – $56.70 |
| 18 | Blue Cross Blue Shield blue essentials (hmo) facility · percent of total billed charges · outpatientfrom % of charges | $14.57 | $18.25 | $0.32 – $56.70 |
| 19 | First Health ppo facility · percent of total billed charges · inpatientfrom % of charges | $14.57 | $18.25 | $0.32 – $56.70 |
| 20 | First Health ppo facility · percent of total billed charges · outpatientfrom % of charges | $14.57 | $18.25 | $0.32 – $56.70 |
| 21 | Humana commercial ppo facility · percent of total billed charges · outpatientfrom % of charges | $14.57 | $18.25 | $0.32 – $56.70 |
| 22 | Blue Cross Blue Shield blue premier/high performance network/my bluehealth facility · percent of total billed charges · outpatientfrom % of charges | $15.41 | $19.30 | $0.34 – $59.94 |
| 23 | Blue Cross Blue Shield bluechoice (ppo) facility · percent of total billed charges · outpatientfrom % of charges | $15.41 | $19.30 | $0.34 – $59.94 |
Last updated: Jun 29, 2026
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