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
Prgrmg Dev Eval Ldls Pm Sys 2chmbr in Person
Smith, AR
See all hospitals reporting CPT 0804T →Price type
Mercy Hospital Fort Smith’s median price of $121 is 180% above the median hospital's median price ($43), higher than 88% of the 1,036 hospitals reporting CPT 0804T. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 13 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 | Blue Cross Blue Shield hb ftsm bcbs exchange facility · fee schedule · outpatient | $36 | $36 | — | — | — | $36 – $36 |
| 2 | Anthem hb ftsm blue cross facility · fee schedule · outpatient | $41 | $41 | — | — | — | $41 – $41 |
| 3 | Blue Cross Blue Shield hb ftsm blue cross facility · fee schedule · outpatient | $41 | $41 | — | — | — | $41 – $41 |
| 4 | Aetna hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $51 | $51 | — | — | — | $51 – $51 |
| 5 | Humana hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $51 | $51 | — | — | — | $51 – $51 |
| 6 | Cigna hb ftsm cigna facility · percent of total billed charges · outpatientfrom % of charges | $115 | $115 | — | — | — | $115 – $115 |
| 7 | Optum hb ftsm,wldar,ozkar,prsar,bnvr uhc facility · percent of total billed charges · outpatientfrom % of charges | $121 | $121 | — | — | — | $121 – $121 |
| 8 | UnitedHealthcare hb ftsm,wldar,ozkar,prsar,bnvr uhc facility · percent of total billed charges · outpatientfrom % of charges | $121 | $121 | — | — | — | $121 – $121 |
| 9 | Aetna hb ftsm coventry/aetna facility · percent of total billed charges · outpatientfrom % of charges | $162 | $162 | — | — | — | $162 – $162 |
| 10 | Humana hb ftsm humana facility · percent of total billed charges · outpatientfrom % of charges | $162 | $162 | — | — | — | $162 – $162 |
| 11 | MultiPlan hb ftsm,wldar,ozkar,prsar multi plan facility · percent of total billed charges · outpatientfrom % of charges | $172 | $172 | — | — | — | $172 – $172 |
| 12 | Medicaid hb ftsm ark medicaid facility · case rate · outpatient | $297 | $297 | — | — | — | $297 – $297 |
| 13 | Caresource hb ftsm caresource medicaid facility · case rate · outpatient | $303 | $303 | — | — | — | $303 – $303 |
Last updated: Jun 8, 2026
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