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
Jacksonville, TX
See all hospitals reporting HCPCS J2004 →Price type
Jacksonville Hospital, LLC’s median price of $43 is 549% above the median hospital's median price ($7), higher than 85% 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, 12 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 | Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges | $30.20 | $31.99 | $18.57 – $51.02 |
| 2 | Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges | $30.20 | $31.99 | $18.57 – $51.02 |
| 3 | Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges | $30.20 | $31.99 | $18.57 – $51.02 |
| 4 | Blue Cross Blue Shield bcbs medicaid [116504] facility · percent of total billed charges · bothfrom % of charges | $31.29 | $33.14 | $19.23 – $52.86 |
| 5 | Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges | $31.29 | $33.14 | $19.23 – $52.86 |
| 6 | UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges | $31.29 | $33.14 | $19.23 – $52.86 |
| 7 | UnitedHealthcare uhc medica choice [206030] facility · percent of total billed charges · bothfrom % of charges | $59.80 | $63.33 | $36.76 – $101.02 |
| 8 | UnitedHealthcare united healthcare student svc [206012] facility · percent of total billed charges · bothfrom % of charges | $59.80 | $63.33 | $36.76 – $101.02 |
| 9 | Cigna cigna ppo [126025] facility · percent of total billed charges · bothfrom % of charges | $67.41 | $71.39 | $41.44 – $113.88 |
| 10 | Cigna cigna - great west [126009] facility · percent of total billed charges · bothfrom % of charges | $77.32 | $81.88 | $47.53 – $130.61 |
| 11 | Humana humana commercial [214001] facility · percent of total billed charges · bothfrom % of charges | $77.32 | $81.88 | $47.53 – $130.61 |
| 12 | Phcs phcs multiplan [178000] facility · percent of total billed charges · bothfrom % of charges | $77.32 | $81.88 | $47.53 – $130.61 |
Last updated: Feb 12, 2026
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