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
Lebanon, NH
See all hospitals reporting HCPCS J2004 →Price type
Mary Hitchcock Memorial Hospital’s median price of $338 is 5037% above the median hospital's median price ($7), higher than 99% 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: 8 payers, 48 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 | Anthem anthem - indemnity/federal employee program professional · fee schedule · outpatient | $0.01 | $0.01 | $0.01 – $0.01 |
| 2 | Anthem anthem hmo/pos; individual non qhp on or off exch; shop off exch - dhp professional · fee schedule · outpatient | $0.01 | $0.01 | $0.01 – $0.01 |
| 3 | Anthem anthem indiv qhp - exchange - dhp professional · fee schedule · outpatient | $0.01 | $0.01 | $0.01 – $0.01 |
| 4 | Anthem anthem ppo - dhp professional · fee schedule · outpatient | $0.01 | $0.01 | $0.01 – $0.01 |
| 5 | Anthem anthem shop - exchange - dhp professional · fee schedule · outpatient | $0.01 | $0.01 | $0.01 – $0.01 |
| 6 | Amerihealth Caritas amerihealth caritas - nh managed medicaid professional · percent of total billed charges · outpatientfrom % of charges | $0.23 | $0.23 | $0.23 – $0.23 |
| 7 | Amerihealth Caritas amerihealth caritas - nh managed medicaid - dhp professional · fee schedule · outpatient | $0.26 | $0.26 | $0.26 – $0.26 |
| 8 | UnitedHealthcare uhc - freedom plan professional · percent of total billed charges · outpatientfrom % of charges | $0.98 | $0.98 | $0.98 – $0.98 |
| 9 | UnitedHealthcare uhc - freedom plan professional · percent of total billed charges · inpatientfrom % of charges | $1.02 | $1.02 | $1.02 – $1.02 |
| 10 | Bcbs Vt bcbs of vermont - the vermont health plan professional · percent of total billed charges · outpatientfrom % of charges | $1.10 | $1.10 | $1.10 – $1.10 |
| 11 | Bcbs Vt bcbs of vermont - vermont health partnership professional · percent of total billed charges · outpatientfrom % of charges | $1.10 | $1.10 | $1.10 – $1.10 |
| 12 | Cigna cigna hmo-pos professional · percent of total billed charges · outpatientfrom % of charges | $1.21 | $1.21 | $1.21 – $1.21 |
| 13 | Aetna aetna hmo/pos/ppo - arnb professional · percent of total billed charges · inpatientfrom % of charges | $1.23 | $1.23 | $1.23 – $1.23 |
| 14 | Aetna aetna hmo/pos/ppo - arnb professional · percent of total billed charges · outpatientfrom % of charges | $1.23 | $1.23 | $1.23 – $1.23 |
| 15 | Bcbs Vt bcbs of vermont non-managed care plans professional · percent of total billed charges · outpatientfrom % of charges | $1.34 | $1.34 | $1.34 – $1.34 |
| 16 | Cigna cigna ppo professional · percent of total billed charges · outpatientfrom % of charges | $1.37 | $1.37 | $1.37 – $1.37 |
| 17 | Aetna aetna hmo/pos/ppo professional · percent of total billed charges · inpatientfrom % of charges | $1.40 | $1.40 | $1.40 – $1.40 |
| 18 | Aetna aetna hmo/pos/ppo professional · percent of total billed charges · outpatientfrom % of charges | $1.40 | $1.40 | $1.40 – $1.40 |
| 19 | UnitedHealthcare uhc - hmo/pos/ppo professional · percent of total billed charges · inpatientfrom % of charges | $1.48 | $1.48 | $1.48 – $1.48 |
| 20 | UnitedHealthcare uhc - hmo/pos/ppo professional · percent of total billed charges · outpatientfrom % of charges | $1.54 | $1.54 | $1.54 – $1.54 |
| 21 | Anthem anthem - federal employee program professional · percent of total billed charges · inpatientfrom % of charges | $1.64 | $1.64 | $1.64 – $1.64 |
| 22 | Anthem anthem - indemnity professional · percent of total billed charges · inpatientfrom % of charges | $1.64 | $1.64 | $1.64 – $1.64 |
| 23 | Anthem anthem - federal employee program professional · percent of total billed charges · outpatientfrom % of charges | $1.74 | $1.74 | $1.74 – $1.74 |
| 24 | First Health first health/hcvm professional · percent of total billed charges · inpatientfrom % of charges | $1.74 | $1.74 | $1.74 – $1.74 |
| 25 | First Health first health/hcvm professional · percent of total billed charges · outpatientfrom % of charges | $1.74 | $1.74 | $1.74 – $1.74 |
Last updated: Jan 1, 2026
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