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
Pittsburg, TX
See all hospitals reporting HCPCS J2004 →Price type
Pittsburg Hospital, LLC’s median price of $22 is 229% above the median hospital's median price ($7), higher than 70% 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: 10 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 | Humana humana medicare advantage/ppo/gold [152503] facility · percent of total billed charges · bothfrom % of charges | $8.10 | $8.02 | $3.71 – $12.17 |
| 2 | Aetna aetna coventry medicare replacement [102002] facility · percent of total billed charges · bothfrom % of charges | $8.27 | $8.18 | $3.78 – $12.41 |
| 3 | Ambetter ambetter [293000] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 4 | Blue Cross Blue Shield blue cross medicare advantage oos [116005] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 5 | Cigna cigna medicare replacement [126500] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 6 | Medicare medicare part a and b [163500] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 7 | Medicare medicare part a only [163502] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 8 | Medicare medicare part b only [163501] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 9 | WellCare wellcare medicare [377501] facility · percent of total billed charges · bothfrom % of charges | $10.13 | $10.02 | $4.63 – $15.21 |
| 10 | Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges | $16.88 | $16.71 | $7.72 – $25.35 |
| 11 | Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges | $16.88 | $16.71 | $7.72 – $25.35 |
| 12 | Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges | $16.88 | $16.71 | $7.72 – $25.35 |
| 13 | UnitedHealthcare united healthcare student svc [206012] facility · percent of total billed charges · bothfrom % of charges | $33.42 | $33.08 | $15.29 – $50.19 |
| 14 | UnitedHealthcare united healthcare texas exchange plan [206034] facility · percent of total billed charges · bothfrom % of charges | $33.76 | $33.42 | $15.45 – $50.70 |
| 15 | Cigna cigna ppo [126025] facility · percent of total billed charges · bothfrom % of charges | $38.41 | $38.03 | $17.58 – $57.70 |
| 16 | Cigna cigna - great west [126009] facility · percent of total billed charges · bothfrom % of charges | $45.24 | $44.78 | $20.70 – $67.94 |
| 17 | Humana humana commercial [214001] facility · percent of total billed charges · bothfrom % of charges | $45.24 | $44.78 | $20.70 – $67.94 |
| 18 | Blue Cross Blue Shield bcbs medicaid [116504] facility · percent of total billed charges · bothfrom % of charges | $92.42 | $91.49 | $42.29 – $138.82 |
| 19 | Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges | $92.42 | $91.49 | $42.29 – $138.82 |
| 20 | Molina molina medicaid new mexico [225500] facility · percent of total billed charges · bothfrom % of charges | $92.42 | $91.49 | $42.29 – $138.82 |
| 21 | UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges | $92.42 | $91.49 | $42.29 – $138.82 |
Last updated: Mar 31, 2026
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