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 (Xylocaine W/Epi) 1 %-1:100000 injection
San Antonio, TX
See all hospitals reporting HCPCS J2004 →Price type
Santa Rosa Hospital - Westover Hills’s median price of $26 is 299% above the median hospital's median price ($7), higher than 74% 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: 11 payers, 30 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 | Bcbs Tx blue advantangehmo fee schedule · outpatient | $0.03 | $0.03 | $0.03 – $0.03 |
| 2 | Bcbs Tx heb fee schedule · outpatient | $0.03 | $0.03 | $0.03 – $0.03 |
| 3 | Bcbs Tx hmo fee schedule · outpatient | $0.03 | $0.03 | $0.03 – $0.03 |
| 4 | Bcbs Tx ppo fee schedule · outpatient | $0.04 | $0.04 | $0.04 – $0.04 |
| 5 | Bcbs Tx traditional fee schedule · outpatient | $0.04 | $0.04 | $0.04 – $0.04 |
| 6 | UnitedHealthcare all payer fee schedule · outpatient | $0.04 | $0.04 | $0.04 – $0.04 |
| 7 | Aetna chip km percent of total billed charges · outpatientfrom % of charges | $12.03 | $15.33 | $5.97 – $48.14 |
| 8 | Aetna star km percent of total billed charges · outpatientfrom % of charges | $12.03 | $15.33 | $5.97 – $48.14 |
| 9 | Bcbs Tx star chip km percent of total billed charges · outpatientfrom % of charges | $12.03 | $15.33 | $5.97 – $48.14 |
| 10 | UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges | $19.69 | $25.08 | $9.77 – $78.78 |
| 11 | UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges | $19.69 | $25.08 | $9.77 – $78.78 |
| 12 | UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges | $19.69 | $25.08 | $9.77 – $78.78 |
| 13 | Aetna mm percent of total billed charges · outpatientfrom % of charges | $25.16 | $32.05 | $12.48 – $100.66 |
| 14 | Molina chip km percent of total billed charges · outpatientfrom % of charges | $32.82 | $41.81 | $16.29 – $131.30 |
| 15 | Molina star plus km percent of total billed charges · outpatientfrom % of charges | $32.82 | $41.81 | $16.29 – $131.30 |
| 16 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $32.82 | $41.81 | $16.29 – $131.30 |
| 17 | Cigna new business percent of total billed charges · outpatientfrom % of charges | $40.48 | $51.57 | $20.09 – $161.93 |
| 18 | Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges | $49.23 | $62.72 | $24.43 – $196.95 |
| 19 | Devoted mm percent of total billed charges · outpatientfrom % of charges | $54.71 | $69.69 | $27.15 – $218.83 |
| 20 | Humana choicecare percent of total billed charges · outpatientfrom % of charges | $54.71 | $69.69 | $27.15 – $218.83 |
| 21 | First Health hmo percent of total billed charges · outpatientfrom % of charges | $55.80 | $71.08 | $27.69 – $223.21 |
| 22 | Aetna new business percent of total billed charges · outpatientfrom % of charges | $59.08 | $75.26 | $29.32 – $236.34 |
| 23 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $60.18 | $76.66 | $29.86 – $240.71 |
| 24 | Aetna epo percent of total billed charges · outpatientfrom % of charges | $65.65 | $83.63 | $32.58 – $262.60 |
| 25 | Aetna hmo percent of total billed charges · outpatientfrom % of charges | $65.65 | $83.63 | $32.58 – $262.60 |
Last updated: Jan 13, 2026
See Lidocaine with epinephrine injection pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.