Single intercostal nerve block injection 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

NJX AA&/STRD NTRCOST NRV 1

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 $699 is 21% below the median hospital's median price ($879), higher than 30% of the 2,257 hospitals reporting CPT 64420. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 64420 at Southeast Texas - Jasper Memorial

Negotiated rates from the hospital’s own file: 9 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	Molina chip km fee schedule · outpatient	$276	$276	—	—	—	$276 – $276
2	Molina star km fee schedule · outpatient	$276	$276	—	—	—	$276 – $276
3	Molina star plus km fee schedule · outpatient	$276	$276	—	—	—	$276 – $276
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	Humana choicecare other · outpatient	$634	$634	—	—	—	$634 – $634
9	Aetna mm fee schedule · outpatient	$699	$699	—	—	—	$699 – $699
10	Bcbs Tx mm fee schedule · outpatient	$699	$699	—	—	—	$699 – $699
11	Humana gold choice mm fee schedule · outpatient	$699	$699	—	—	—	$699 – $699
12	Molina medicare adv mm fee schedule · outpatient	$699	$699	—	—	—	$699 – $699
13	UnitedHealthcare mm fee schedule · outpatient	$699	$699	—	—	—	$699 – $699
14	WellCare mm fee schedule · outpatient	$699	$699	—	—	—	$699 – $699
15	Devoted mm fee schedule · outpatient	$755	$755	—	—	—	$755 – $755
16	Bcbs Tx heb fee schedule · outpatient	$925	$925	—	—	—	$925 – $925
17	UnitedHealthcare hix case rate · outpatient	$1.1k	$1.1k	—	—	—	$1.1k – $1.1k
18	Bcbs Tx blue advantage hmo fee schedule · outpatient	$1.5k	$1.5k	—	—	—	$1.5k – $1.5k
19	Bcbs Tx hmo fee schedule · outpatient	$1.6k	$1.6k	—	—	—	$1.6k – $1.6k
20	Aetna new business case rate · outpatient	$1.7k	$1.7k	—	—	—	$1.7k – $1.7k
21	Bcbs Tx ppo fee schedule · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
22	Aetna epo case rate · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
23	Aetna hmo case rate · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
24	Aetna pos case rate · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k
25	Aetna ppo case rate · outpatient	$1.9k	$1.9k	—	—	—	$1.9k – $1.9k

Page 1 of 2 · 30 rates

Last updated: Jan 13, 2026

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