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
Guthrie, OK
See all hospitals reporting HCPCS J2004 →Price type
Mercy Hospital Logan County Inc’s median price of $20 is 204% above the median hospital's median price ($7), higher than 69% 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: 17 payers, 36 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 lgnok ok medicaid (soonercare) facility · fee schedule · outpatient | $4.00 | $4.00 | $4.00 – $4.00 |
| 2 | Humana hb lgnok ok medicaid (soonercare) facility · fee schedule · outpatient | $4.00 | $4.00 | $4.00 – $4.00 |
| 3 | Medicaid hb lgnok ok medicaid (soonercare) facility · fee schedule · outpatient | $4.00 | $4.00 | $4.00 – $4.00 |
| 4 | Tricare hb lgnok tricare facility · percent of total billed charges · outpatientfrom % of charges | $9.35 | $9.35 | $9.35 – $9.35 |
| 5 | UnitedHealthcare hb lgnok uhc medicare new 040122 w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $9.61 | $9.61 | $9.61 – $9.61 |
| 6 | Ambetter hb lgnok ambetter exchange medicare facility · percent of total billed charges · outpatientfrom % of charges | $11.31 | $11.31 | $11.31 – $11.31 |
| 7 | Aetna hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $13.57 | $13.57 | $13.57 – $13.57 |
| 8 | Blue Cross Blue Shield hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $13.57 | $13.57 | $13.57 – $13.57 |
| 9 | First Health hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $13.57 | $13.57 | $13.57 – $13.57 |
| 10 | Humana hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $13.57 | $13.57 | $13.57 – $13.57 |
| 11 | UnitedHealthcare hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $13.57 | $13.57 | $13.57 – $13.57 |
| 12 | WellCare hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $13.57 | $13.57 | $13.57 – $13.57 |
| 13 | Medica hb lgnok medica medicare new 031523 facility · percent of total billed charges · outpatientfrom % of charges | $13.68 | $13.68 | $13.68 – $13.68 |
| 14 | Medicare hb lgnok medicare facility · percent of total billed charges · outpatientfrom % of charges | $13.68 | $13.68 | $13.68 – $13.68 |
| 15 | Cigna hb lgnok cigna mcr w/seq 103% facility · percent of total billed charges · outpatientfrom % of charges | $14.07 | $14.07 | $14.07 – $14.07 |
| 16 | Blue Cross Blue Shield hb lgnok bcbs of ok nativeblue mcr 103% (no seq) facility · percent of total billed charges · outpatientfrom % of charges | $14.36 | $14.36 | $14.36 – $14.36 |
| 17 | Devoted hb lgnok devoted health mcr 104% w/o seq facility · percent of total billed charges · outpatientfrom % of charges | $16.07 | $16.07 | $16.07 – $16.07 |
| 18 | Blue Cross Blue Shield hb lgnok blue cross advantage ppo facility · percent of total billed charges · outpatientfrom % of charges | $18.85 | $18.85 | $18.85 – $18.85 |
| 19 | Blue Cross Blue Shield hb lgnok blue cross preferred facility · percent of total billed charges · outpatientfrom % of charges | $18.85 | $18.85 | $18.85 – $18.85 |
| 20 | Blue Cross Blue Shield hb lgnok blue lincs facility · percent of total billed charges · outpatientfrom % of charges | $18.85 | $18.85 | $18.85 – $18.85 |
| 21 | Blue Cross Blue Shield hb lgnok blue traditional facility · percent of total billed charges · outpatientfrom % of charges | $18.85 | $18.85 | $18.85 – $18.85 |
| 22 | Medica hb lgnok medica exchange mcr 136% no seq facility · percent of total billed charges · outpatientfrom % of charges | $18.85 | $18.85 | $18.85 – $18.85 |
| 23 | Anthem hb lgnok blue choice facility · percent of total billed charges · outpatientfrom % of charges | $19.98 | $19.98 | $19.98 – $19.98 |
| 24 | Blue Cross Blue Shield hb lgnok blue choice facility · percent of total billed charges · outpatientfrom % of charges | $19.98 | $19.98 | $19.98 – $19.98 |
| 25 | Aetna hb lgnok aetna nbd facility · percent of total billed charges · outpatientfrom % of charges | $20.28 | $20.28 | $20.28 – $20.28 |
Last updated: Jun 11, 2026
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