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
Booneville, AR
See all hospitals reporting HCPCS J2004 →Price type
Mercy Hospital Booneville’s median price of $16 is 136% above the median hospital's median price ($7), higher than 65% 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: 15 payers, 21 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 hb bnvar ok managed medicaid facility · fee schedule · outpatient | $6.00 | $6.00 | $2.00 – $10.00 |
| 2 | Humana hb bnvar ok managed medicaid facility · fee schedule · outpatient | $6.00 | $6.00 | $2.00 – $10.00 |
| 3 | Medicaid hb bnvar ok medicaid facility · fee schedule · outpatient | $6.00 | $6.00 | $2.00 – $10.00 |
| 4 | Anthem hb bnvar blue cross facility · fee schedule · outpatient | $9.00 | $9.00 | $3.00 – $15.00 |
| 5 | Blue Cross Blue Shield hb bnvar blue cross facility · fee schedule · outpatient | $9.00 | $9.00 | $3.00 – $15.00 |
| 6 | Aetna hb bnvar managed medicare facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 7 | Blue Cross Blue Shield hb bnvar managed medicare facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 8 | First Health hb bnvar managed medicare facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 9 | Humana hb bnvar humana mcr facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 10 | Humana hb bnvar managed medicare facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 11 | Medica hb bnvar managed medicare facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 12 | Medicare hb bnvar medicare facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 13 | UnitedHealthcare hb bnvar uhc medicare 100% facility · percent of total billed charges · outpatientfrom % of charges | $7.89 | $9.87 | $5.54 – $18.17 |
| 14 | Tricare hb bnvar tricare facility · percent of total billed charges · outpatientfrom % of charges | $7.92 | $9.91 | $5.56 – $18.24 |
| 15 | WellCare hb bnvar novasys mcr 103% facility · percent of total billed charges · outpatientfrom % of charges | $8.12 | $10.17 | $5.70 – $18.72 |
| 16 | Devoted hb bnvar devoted health mcr facility · percent of total billed charges · outpatientfrom % of charges | $8.20 | $10.27 | $5.76 – $18.90 |
| 17 | Cigna hb bnvar healthspring 105% mcr facility · percent of total billed charges · outpatientfrom % of charges | $8.28 | $10.36 | $5.81 – $19.08 |
| 18 | Ambetter hb bnvar novasys ambetter exchange facility · percent of total billed charges · outpatientfrom % of charges | $10.88 | $13.62 | $7.64 – $25.07 |
| 19 | Aetna hb wldar,ozkar,prsar,bnvr conventry/aetna facility · percent of total billed charges · outpatientfrom % of charges | $17.42 | $21.80 | $12.23 – $40.14 |
| 20 | MultiPlan hb bnvar multiplan facility · percent of total billed charges · outpatientfrom % of charges | $21.43 | $26.83 | $15.05 – $49.40 |
| 21 | Cigna hb bnvar cigna facility · percent of total billed charges · outpatientfrom % of charges | $22.77 | $28.51 | $15.99 – $52.49 |
Last updated: Jun 8, 2026
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