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
Perryville, MO
See all hospitals reporting HCPCS J2004 →Price type
Mercy Perry’s median price of $22 is 236% above the median hospital's median price ($7), higher than 71% 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: 16 payers, 29 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 | Medicaid hb wash jefn linc samc pcmh stod il medicaid facility · percent of total billed charges · outpatientfrom % of charges | $7.94 | $7.63 | $3.91 – $10.74 |
| 2 | Optum hb pcmh uhc all payer exchange facility · fee schedule · outpatient | $10.00 | $10.00 | $5.00 – $15.00 |
| 3 | UnitedHealthcare hb pcmh uhc all payer exchange facility · fee schedule · outpatient | $10.00 | $10.00 | $5.00 – $15.00 |
| 4 | UnitedHealthcare hb pcmh uhc core facility · fee schedule · outpatient | $10.00 | $10.00 | $5.00 – $15.00 |
| 5 | Blue Cross Blue Shield hb pcmh missouri care health plan/healthy blue facility · percent of total billed charges · outpatientfrom % of charges | $10.58 | $10.17 | $5.21 – $14.31 |
| 6 | Medicaid hb pcmh mo medicaid facility · percent of total billed charges · outpatientfrom % of charges | $10.58 | $10.17 | $5.21 – $14.31 |
| 7 | UnitedHealthcare hb pcmh uhc managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $10.58 | $10.17 | $5.21 – $14.31 |
| 8 | Blue Cross Blue Shield hb pcmh medicare/managed mcr w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $16.09 | $15.46 | $7.92 – $21.76 |
| 9 | Humana hb pcmh medicare/managed mcr w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $16.09 | $15.46 | $7.92 – $21.76 |
| 10 | Medica hb pcmh medicare/managed mcr w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $16.09 | $15.46 | $7.92 – $21.76 |
| 11 | Medicare hb pcmh medicare/managed mcr w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $16.09 | $15.46 | $7.92 – $21.76 |
| 12 | UnitedHealthcare hb pcmh medicare/managed mcr w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $16.09 | $15.46 | $7.92 – $21.76 |
| 13 | WellCare hb pcmh medicare/managed mcr w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $16.09 | $15.46 | $7.92 – $21.76 |
| 14 | UnitedHealthcare hb pcmh uhc medicare w/o seq facility · percent of total billed charges · outpatientfrom % of charges | $16.40 | $15.77 | $8.07 – $22.19 |
| 15 | Aetna hb pcmh aetna/coventry medicare 102% w/o seq facility · percent of total billed charges · outpatientfrom % of charges | $16.73 | $16.08 | $8.23 – $22.63 |
| 16 | Devoted hb pcmh devoted health medicare advantage 104% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $16.74 | $16.09 | $8.24 – $22.64 |
| 17 | Tricare hb pcmh tricare facility · percent of total billed charges · outpatientfrom % of charges | $19.18 | $18.43 | $9.44 – $25.94 |
| 18 | Medica hb linc pcmh medica exchange new 010122 facility · percent of total billed charges · outpatientfrom % of charges | $22.22 | $21.36 | $10.94 – $30.06 |
| 19 | Ambetter hb pcmh ambetter exchange facility · percent of total billed charges · outpatientfrom % of charges | $25.08 | $24.10 | $12.34 – $33.92 |
| 20 | Blue Cross Blue Shield hb stlo wash jefn linc samc cape stod pcmh bcbs ascension facility · percent of total billed charges · outpatientfrom % of charges | $25.13 | $24.16 | $12.37 – $34.00 |
| 21 | Blue Cross Blue Shield hb pcmh anthem blue preferred facility · percent of total billed charges · outpatientfrom % of charges | $32.80 | $31.53 | $16.14 – $44.37 |
| 22 | Blue Cross Blue Shield hb pcmh anthem pathway/exchange facility · percent of total billed charges · outpatientfrom % of charges | $32.80 | $31.53 | $16.14 – $44.37 |
| 23 | Aetna hb pcmh linc aetna coventry all products facility · percent of total billed charges · outpatientfrom % of charges | $34.65 | $33.31 | $17.06 – $46.88 |
| 24 | First Health hb pcmh linc aetna coventry all products facility · percent of total billed charges · outpatientfrom % of charges | $34.65 | $33.31 | $17.06 – $46.88 |
| 25 | Anthem hb pcmh anthem blue access facility · percent of total billed charges · outpatientfrom % of charges | $37.03 | $35.60 | $18.23 – $50.10 |
Last updated: Mar 12, 2026
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