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
CLOSTRIDIUM TOXIN A W/OPTIC
Jasper, TX
See all hospitals reporting CPT 87803 →Price type
Southeast Texas - Jasper Memorial’s median price of $17 is 3% above the median hospital's median price ($17), higher than 64% of the 1,369 hospitals reporting CPT 87803. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 24 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 | UnitedHealthcare all payer fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 2 | UnitedHealthcare hix fee schedule · outpatient | $14 | $14 | — | — | — | $14 – $14 |
| 3 | UnitedHealthcare chip km fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 4 | UnitedHealthcare star kid km fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 5 | UnitedHealthcare star km fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 6 | UnitedHealthcare star plus km fee schedule · outpatient | $15 | $15 | — | — | — | $15 – $15 |
| 7 | Molina chip km fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 8 | Molina star km fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 9 | Molina star plus km fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 10 | Aetna mm fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 11 | Bcbs Tx mm fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 12 | Humana gold choice mm fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 13 | Molina medicare adv mm fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 14 | UnitedHealthcare mm fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 15 | WellCare mm fee schedule · outpatient | $17 | $17 | — | — | — | $17 – $17 |
| 16 | Devoted mm fee schedule · outpatient | $19 | $19 | — | — | — | $19 – $19 |
| 17 | Humana choicecare fee schedule · outpatient | $38 | $38 | — | — | — | $38 – $38 |
| 18 | Cigna new business fee schedule · outpatient | $56 | $56 | — | — | — | $56 – $56 |
| 19 | Cigna ppo fee schedule · outpatient | $72 | $72 | — | — | — | $72 – $72 |
| 20 | Bcbs Tx blue advantage hmo fee schedule · outpatient | $86 | $86 | — | — | — | $86 – $86 |
| 21 | Bcbs Tx heb fee schedule · outpatient | $95 | $95 | — | — | — | $95 – $95 |
| 22 | Bcbs Tx hmo fee schedule · outpatient | $95 | $95 | — | — | — | $95 – $95 |
| 23 | Bcbs Tx ppo fee schedule · outpatient | $108 | $108 | — | — | — | $108 – $108 |
| 24 | Bcbs Tx traditional fee schedule · outpatient | $112 | $112 | — | — | — | $112 – $112 |
Last updated: Jan 13, 2026
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