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 200MG/EPI 0.2MG MDV
Dallas, TX
See all hospitals reporting HCPCS J2004 →Price type
Medical City Dallas’s median price of $16 is 150% above the median hospital's median price ($7), higher than 66% 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: 7 payers, 38 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 | Blue Cross Blue Shield blueadvantagehmo fee schedule · outpatient | $0.03 | $0.03 | $0.03 – $0.03 |
| 2 | Blue Cross Blue Shield mybluehealth fee schedule · outpatient | $0.03 | $0.03 | $0.03 – $0.03 |
| 3 | Blue Cross Blue Shield blueessentials fee schedule · outpatient | $0.05 | $0.05 | $0.05 – $0.05 |
| 4 | Blue Cross Blue Shield blueessentialsaccess fee schedule · outpatient | $0.05 | $0.05 | $0.05 – $0.05 |
| 5 | Blue Cross Blue Shield eposoa fee schedule · outpatient | $0.05 | $0.05 | $0.05 – $0.05 |
| 6 | Blue Cross Blue Shield ppo fee schedule · outpatient | $0.06 | $0.06 | $0.06 – $0.06 |
| 7 | Cigna localplus fee schedule · outpatient | $0.06 | $0.06 | $0.06 – $0.06 |
| 8 | Cigna newbusiness fee schedule · outpatient | $0.06 | $0.06 | $0.06 – $0.06 |
| 9 | Cigna hmo fee schedule · outpatient | $0.07 | $0.07 | $0.07 – $0.07 |
| 10 | Cigna networkbenefit fee schedule · outpatient | $0.07 | $0.07 | $0.07 – $0.07 |
| 11 | Cigna openaccessplus fee schedule · outpatient | $0.07 | $0.07 | $0.07 – $0.07 |
| 12 | UnitedHealthcare allpayerappendix fee schedule · outpatient | $0.07 | $0.07 | $0.07 – $0.07 |
| 13 | UnitedHealthcare narrownetworkindivexchange fee schedule · outpatient | $0.07 | $0.07 | $0.07 – $0.07 |
| 14 | UnitedHealthcare smallgroup fee schedule · outpatient | $0.07 | $0.07 | $0.07 – $0.07 |
| 15 | Cigna allother fee schedule · outpatient | $0.09 | $0.09 | $0.09 – $0.09 |
| 16 | Superior Healthplan chip percent of total billed charges · outpatientfrom % of charges | $3.88 | $3.69 | $1.39 – $8.26 |
| 17 | Superior Healthplan mcdstar percent of total billed charges · outpatientfrom % of charges | $3.88 | $3.69 | $1.39 – $8.26 |
| 18 | Superior Healthplan starhealth percent of total billed charges · outpatientfrom % of charges | $3.88 | $3.69 | $1.39 – $8.26 |
| 19 | Superior Healthplan starkids percent of total billed charges · outpatientfrom % of charges | $3.88 | $3.69 | $1.39 – $8.26 |
| 20 | Superior Healthplan starplus percent of total billed charges · outpatientfrom % of charges | $3.88 | $3.69 | $1.39 – $8.26 |
| 21 | Optum mcd percent of total billed charges · outpatientfrom % of charges | $6.09 | $5.80 | $2.18 – $12.98 |
| 22 | Cigna ifp percent of total billed charges · outpatientfrom % of charges | $7.48 | $7.12 | $2.68 – $15.93 |
| 23 | Cigna qhp percent of total billed charges · outpatientfrom % of charges | $7.75 | $7.38 | $2.78 – $16.52 |
| 24 | Aetna qhphix percent of total billed charges · outpatientfrom % of charges | $9.03 | $8.60 | $3.23 – $19.23 |
| 25 | UnitedHealthcare optionsppo percent of total billed charges · outpatientfrom % of charges | $11.91 | $11.34 | $4.27 – $25.36 |
Last updated: Mar 1, 2026
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