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 20 MG/ML (2 %)-EPINEPHRINE 1:100,000 INJECTION SOLUTION
Delta, UT
See all hospitals reporting HCPCS J2004 →Price type
IHC Health Services Inc., DBA Intermountain Health Delta Community Hospital’s median price of $22 is 242% above the median hospital's median price ($7), higher than 71% 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: 6 payers, 40 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 | Aetna medicare adv hmo facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 2 | Aetna medicare adv ppo facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 3 | Humana medicare choice ppo facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 4 | Molina medicaid facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 5 | Molina medicare complete care hmo snp facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 6 | Regence medadvantage ppo facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 7 | UnitedHealthcare medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $7.57 | $11.86 | $7.48 – $20.52 |
| 8 | Molina medicaid facility · percent of total billed charges · inpatientfrom % of charges | $21.06 | $32.98 | $20.80 – $57.07 |
| 9 | Aetna connected facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 10 | Aetna extended facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 11 | Aetna standard facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 12 | Aetna standard facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 13 | Cigna hmo facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 14 | Cigna hmo facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 15 | Cigna open access flex facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 16 | Cigna open access flex facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 17 | Cigna ppo/epo facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 18 | Cigna ppo/epo facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 19 | Molina chip facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 20 | Molina chip facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 21 | Molina marketplace facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 22 | Molina marketplace facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 23 | Regence blueoption facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 24 | Regence blueoption facility · percent of total billed charges · outpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
| 25 | Regence fehbp facility · percent of total billed charges · inpatientfrom % of charges | $22.48 | $35.20 | $22.20 – $60.91 |
Last updated: Jul 28, 2026
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