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-EPINEPHRINE (PF) 2 %-1:200,000 INJ SOLN
Sandwich, IL
See all hospitals reporting HCPCS J2004 →Price type
Northwestern Medicine Valley West Hospital’s median price of $22 is 233% 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: 7 payers, 17 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 vwh illinois medicaid percent of total billed charges · outpatientfrom % of charges | $11.69 | $13.81 | $0.53 – $39.90 |
| 2 | Cigna Healthspring vwh illinois medicaid percent of total billed charges · outpatientfrom % of charges | $11.69 | $13.81 | $0.53 – $39.90 |
| 3 | Blue Cross Blue Shield vwh blue cross medicare advt percent of total billed charges · outpatientfrom % of charges | $32.18 | $38.04 | $1.47 – $109.87 |
| 4 | Humana vwh medicare percent of total billed charges · outpatientfrom % of charges | $32.18 | $38.04 | $1.47 – $109.87 |
| 5 | Aetna vwh aetna nm employees percent of total billed charges · outpatientfrom % of charges | $43.02 | $50.85 | $1.97 – $146.88 |
| 6 | Aetna vwh aetna il preferred percent of total billed charges · outpatientfrom % of charges | $58.95 | $69.67 | $2.70 – $201.23 |
| 7 | Blue Cross Blue Shield vwh bcbs par/indemnity adp percent of total billed charges · outpatientfrom % of charges | $94.68 | $111.90 | $4.33 – $323.24 |
| 8 | Blue Cross Blue Shield vwh bcbs bluechoice options percent of total billed charges · outpatientfrom % of charges | $102.31 | $120.91 | $4.68 – $349.26 |
| 9 | Blue Cross Blue Shield vwh bcbs bluechoice select percent of total billed charges · outpatientfrom % of charges | $102.31 | $120.91 | $4.68 – $349.26 |
| 10 | Blue Cross Blue Shield vwh bcbs bluechoice preferred percent of total billed charges · outpatientfrom % of charges | $106.71 | $126.12 | $4.88 – $364.30 |
| 11 | Blue Cross Blue Shield vwh bcbs hmo percent of total billed charges · outpatientfrom % of charges | $110.35 | $130.42 | $5.05 – $376.73 |
| 12 | MultiPlan vwh phcs percent of total billed charges · outpatientfrom % of charges | $135.50 | $160.15 | $6.20 – $462.60 |
| 13 | Blue Cross Blue Shield vwh bcbs ppo percent of total billed charges · outpatientfrom % of charges | $138.38 | $163.55 | $6.33 – $472.43 |
| 14 | MultiPlan vwh multiplan percent of total billed charges · outpatientfrom % of charges | $148.21 | $175.16 | $6.78 – $505.97 |
| 15 | First Health vwh non-contracted payors percent of total billed charges · outpatientfrom % of charges | $169.38 | $200.19 | $7.75 – $578.25 |
| 16 | MultiPlan vwh non-contracted payors percent of total billed charges · outpatientfrom % of charges | $169.38 | $200.19 | $7.75 – $578.25 |
| 17 | UnitedHealthcare vwh uhc non-contracted oon - ed only percent of total billed charges · outpatientfrom % of charges | $169.38 | $200.19 | $7.75 – $578.25 |
Last updated: Apr 1, 2026
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