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
BARRIER SEPRAFILM 5X6IN 430102
Smith, AR
See all hospitals reporting HCPCS C1765 →Price type
Mercy Hospital Fort Smith’s median price of $220 is 74% below the median hospital's median price ($845), higher than 8% of the 1,293 hospitals reporting HCPCS C1765. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 4 payers, 5 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 | Aetna hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $92 | $106 | $34 | 32% | — | $78 – $169 |
| 2 | Humana hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $92 | $106 | $34 | 32% | — | $78 – $169 |
| 3 | Humana hb ftsm humana facility · percent of total billed charges · outpatientfrom % of charges | $275 | $319 | $103 | 32% | — | $233 – $508 |
| 4 | Cigna hb ftsm cigna facility · percent of total billed charges · outpatientfrom % of charges | $339 | $339 | — | — | — | $339 – $339 |
| 5 | MultiPlan hb ftsm,wldar,ozkar,prsar multi plan facility · percent of total billed charges · outpatientfrom % of charges | $312 | $362 | $117 | 32% | — | $264 – $575 |
Last updated: Jun 8, 2026
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