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
Tishomingo, OK
See all hospitals reporting HCPCS J2004 →Price type
Mercy Hospital Tishomingo Inc’s median price of $20 is 205% 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, 37 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 tish ok medicaid (soonercare) facility · fee schedule · outpatient | $6.00 | $6.00 | $4.00 – $8.00 |
| 2 | Humana hb tish ok medicaid (soonercare) facility · fee schedule · outpatient | $6.00 | $6.00 | $4.00 – $8.00 |
| 3 | Medicaid hb tish ok medicaid (soonercare) facility · fee schedule · outpatient | $6.00 | $6.00 | $4.00 – $8.00 |
| 4 | Ambetter hb tish ambetter exchange medicare facility · percent of total billed charges · outpatientfrom % of charges | $12.69 | $12.69 | $12.60 – $12.78 |
| 5 | Blue Cross Blue Shield hb tish blue cross advantage ppo facility · percent of total billed charges · outpatientfrom % of charges | $13.54 | $13.54 | $13.44 – $13.63 |
| 6 | Blue Cross Blue Shield hb tish blue traditional facility · percent of total billed charges · outpatientfrom % of charges | $15.65 | $15.65 | $15.54 – $15.76 |
| 7 | Anthem hb tish blue choice facility · percent of total billed charges · outpatientfrom % of charges | $18.61 | $18.61 | $18.48 – $18.74 |
| 8 | Blue Cross Blue Shield hb tish blue choice facility · percent of total billed charges · outpatientfrom % of charges | $18.61 | $18.61 | $18.48 – $18.74 |
| 9 | Aetna hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 10 | Blue Cross Blue Shield hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 11 | First Health hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 12 | Humana hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 13 | Medica hb tish medica medicare new 031523 facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 14 | Medicare hb tish medicare facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 15 | Tricare hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 16 | Tricare hb tish tricare facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 17 | UnitedHealthcare hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 18 | WellCare hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $19.51 | $19.51 | $19.37 – $19.64 |
| 19 | Cigna hb tish cigna mcr w/seq 103% facility · percent of total billed charges · outpatientfrom % of charges | $20.09 | $20.09 | $19.95 – $20.23 |
| 20 | Blue Cross Blue Shield hb tish blue cross preferred facility · percent of total billed charges · outpatientfrom % of charges | $20.31 | $20.31 | $20.16 – $20.45 |
| 21 | Blue Cross Blue Shield hb tish blue lincs facility · percent of total billed charges · outpatientfrom % of charges | $20.31 | $20.31 | $20.16 – $20.45 |
| 22 | UnitedHealthcare hb tish uhc medicare new 040122 w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $20.34 | $20.34 | $20.19 – $20.48 |
| 23 | Blue Cross Blue Shield hb tish bcbs of ok nativeblue mcr 103% (no seq) facility · percent of total billed charges · outpatientfrom % of charges | $20.48 | $20.48 | $20.33 – $20.62 |
| 24 | Devoted hb tish devoted health mcr 104% w/o seq facility · percent of total billed charges · outpatientfrom % of charges | $20.68 | $20.68 | $20.53 – $20.82 |
| 25 | Aetna hb tish aetna nbd facility · percent of total billed charges · outpatientfrom % of charges | $26.06 | $26.06 | $25.87 – $26.24 |
Last updated: Jun 11, 2026
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