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
Rpr Blepharoptosis Levator Rescj/Advmnt Xtrnl
Smith, AR
See all hospitals reporting CPT 67904 →Price type
Mercy Hospital Fort Smith’s median price of $2.3k is 17% below the median hospital's median price ($2.7k), higher than 27% of the 1,685 hospitals reporting CPT 67904. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 15 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 | Medicaid hb ftsm ark medicaid facility · fee schedule · outpatient | $320 | $320 | — | — | — | $320 – $320 |
| 2 | Caresource hb ftsm caresource medicaid facility · fee schedule · outpatient | $326 | $326 | — | — | — | $326 – $326 |
| 3 | Blue Cross Blue Shield hb ftsm managed medicare facility · fee schedule · outpatient | $459 | $459 | — | — | — | $459 – $459 |
| 4 | Humana hb ftsm humana facility · fee schedule · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 5 | Aetna hb ftsm ok managed medicaid facility · fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 6 | Humana hb ftsm ok managed medicaid facility · fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 7 | Medicaid hb ftsm ok medicaid facility · fee schedule · outpatient | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 8 | Aetna hb ftsm managed medicare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 9 | Blue Cross Blue Shield hb ftsm managed medicare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 10 | First Health hb ftsm managed medicare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 11 | Humana hb ftsm humana mcr facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 12 | Medica hb ftsm managed medicare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 13 | Medicare hb ftsm medicare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 14 | Tricare hb ftsm tricare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 15 | UnitedHealthcare hb ftsm managed medicare facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 16 | UnitedHealthcare hb ftsm uhc mcr 100% facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 17 | WellCare hb ftsm novasys mcr 103% facility · other · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 18 | Devoted hb ftsm devoted health mcr facility · other · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 19 | Cigna hb ftsm healthspring cigna mcr 105% facility · other · outpatient | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 20 | Blue Cross Blue Shield hb ftsm bcbs exchange facility · fee schedule · outpatient | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 21 | Anthem hb ftsm blue cross facility · fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 22 | Blue Cross Blue Shield hb ftsm blue cross facility · fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 23 | Medicaid hb ftsm mo medicaid facility · fee schedule · outpatient | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 24 | Ambetter hb ftsm novasys ambetter exchange facility · other · outpatient | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
Last updated: Jun 8, 2026
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