Repair of split wound at Southeast Texas - Jasper Memorial

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

TX SUPFC WND DEHSN W/PACKING

Jasper, TX

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Pricing by billing methodology

Price type

How this price compares nationally

Southeast Texas - Jasper Memorial’s median price of $403 is 20% below the median hospital's median price ($503), higher than 33% of the 1,979 hospitals reporting CPT 12021. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 12021 at Southeast Texas - Jasper Memorial

Negotiated rates from the hospital’s own file: 8 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	Molina chip km fee schedule · outpatient	$150	$150	—	—	—	$150 – $150
2	Molina star km fee schedule · outpatient	$150	$150	—	—	—	$150 – $150
3	Molina star plus km fee schedule · outpatient	$150	$150	—	—	—	$150 – $150
4	UnitedHealthcare chip km case rate · outpatient	$285	$285	—	—	—	$285 – $285
5	UnitedHealthcare star kid km case rate · outpatient	$285	$285	—	—	—	$285 – $285
6	UnitedHealthcare star km case rate · outpatient	$285	$285	—	—	—	$285 – $285
7	UnitedHealthcare star plus km case rate · outpatient	$285	$285	—	—	—	$285 – $285
8	Aetna mm fee schedule · outpatient	$403	$403	—	—	—	$403 – $403
9	Bcbs Tx mm fee schedule · outpatient	$403	$403	—	—	—	$403 – $403
10	Humana gold choice mm fee schedule · outpatient	$403	$403	—	—	—	$403 – $403
11	Molina medicare adv mm fee schedule · outpatient	$403	$403	—	—	—	$403 – $403
12	UnitedHealthcare mm fee schedule · outpatient	$403	$403	—	—	—	$403 – $403
13	WellCare mm fee schedule · outpatient	$403	$403	—	—	—	$403 – $403
14	Humana choicecare other · outpatient	$417	$417	—	—	—	$417 – $417
15	Devoted mm fee schedule · outpatient	$435	$435	—	—	—	$435 – $435
16	Bcbs Tx heb fee schedule · outpatient	$473	$473	—	—	—	$473 – $473
17	UnitedHealthcare hix case rate · outpatient	$599	$599	—	—	—	$599 – $599
18	Bcbs Tx blue advantage hmo fee schedule · outpatient	$754	$754	—	—	—	$754 – $754
19	Bcbs Tx hmo fee schedule · outpatient	$796	$796	—	—	—	$796 – $796
20	Bcbs Tx ppo fee schedule · outpatient	$968	$968	—	—	—	$968 – $968
21	Bcbs Tx traditional fee schedule · outpatient	$1.1k	$1.1k	—	—	—	$1.1k – $1.1k
22	UnitedHealthcare all payer case rate · outpatient	$1.3k	$1.3k	—	—	—	$1.3k – $1.3k
23	Aetna new business case rate · outpatient	$1.7k	$1.7k	—	—	—	$1.7k – $1.7k
24	Aetna epo case rate · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
25	Aetna hmo case rate · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k

Page 1 of 2 · 29 rates

Last updated: Jan 13, 2026

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