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) (Xylocaine W/Epi) 1 %-1:200000 injection
Jasper, TX
See all hospitals reporting HCPCS J2004 →Price type
Southeast Texas - Jasper Memorial’s median price of $60 is 815% above the median hospital's median price ($7), higher than 92% 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.
Filter by billing methodology
Filter by billing class
| # | ||||
|---|---|---|---|---|
| 1 | Bcbs Tx blue advantage hmo fee schedule · outpatient | $0.04 | $0.04 | $0.04 – $0.04 |
| 2 | UnitedHealthcare all payer fee schedule · outpatient | $0.04 | $0.04 | $0.04 – $0.04 |
| 3 | UnitedHealthcare hix fee schedule · outpatient | $0.04 | $0.04 | $0.04 – $0.04 |
| 4 | Bcbs Tx heb fee schedule · outpatient | $0.05 | $0.05 | $0.05 – $0.05 |
| 5 | Bcbs Tx hmo fee schedule · outpatient | $0.05 | $0.05 | $0.05 – $0.05 |
| 6 | Bcbs Tx ppo fee schedule · outpatient | $0.06 | $0.06 | $0.06 – $0.06 |
| 7 | Bcbs Tx traditional fee schedule · outpatient | $0.06 | $0.06 | $0.06 – $0.06 |
| 8 | UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges | $30.11 | $25.30 | $1.25 – $30.11 |
| 9 | UnitedHealthcare star kid km percent of total billed charges · outpatientfrom % of charges | $30.11 | $25.30 | $1.25 – $30.11 |
| 10 | UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges | $30.11 | $25.30 | $1.25 – $30.11 |
| 11 | UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges | $30.11 | $25.30 | $1.25 – $30.11 |
| 12 | Aetna mm percent of total billed charges · outpatientfrom % of charges | $51.63 | $43.38 | $2.15 – $51.63 |
| 13 | Molina chip km percent of total billed charges · outpatientfrom % of charges | $64.53 | $54.22 | $2.69 – $64.53 |
| 14 | Molina star km percent of total billed charges · outpatientfrom % of charges | $64.53 | $54.22 | $2.69 – $64.53 |
| 15 | Molina star plus km percent of total billed charges · outpatientfrom % of charges | $64.53 | $54.22 | $2.69 – $64.53 |
| 16 | UnitedHealthcare hix percent of total billed charges · outpatientfrom % of charges | $60.23 | $60.23 | $60.23 – $60.23 |
| 17 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $64.53 | $64.53 | $64.53 – $64.53 |
| 18 | Cigna new business percent of total billed charges · outpatientfrom % of charges | $83.90 | $70.50 | $3.50 – $83.90 |
| 19 | Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges | $96.80 | $81.34 | $4.04 – $96.80 |
| 20 | Devoted mm percent of total billed charges · outpatientfrom % of charges | $107.56 | $90.38 | $4.49 – $107.56 |
| 21 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $129.07 | $108.46 | $5.38 – $129.07 |
| 22 | Humana choicecare percent of total billed charges · outpatientfrom % of charges | $129.07 | $108.46 | $5.38 – $129.07 |
| 23 | Aetna new business percent of total billed charges · outpatientfrom % of charges | $133.38 | $112.08 | $5.56 – $133.38 |
| 24 | First Health ppo percent of total billed charges · outpatientfrom % of charges | $139.83 | $117.50 | $5.83 – $139.83 |
| 25 | Aetna epo percent of total billed charges · outpatientfrom % of charges | $148.43 | $124.72 | $6.19 – $148.43 |
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.