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
Fa Brace Tlso Prefab
Smith, AR
See all hospitals reporting HCPCS L0454 →Price type
Mercy Hospital Fort Smith’s median price of $420 is 4% below the median hospital's median price ($437), higher than 30% of the 849 hospitals reporting HCPCS L0454. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 13 payers, 20 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 | $139 | $139 | — | — | — | $139 – $139 |
| 2 | Humana hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $139 | $139 | — | — | — | $139 – $139 |
| 3 | Cigna hb ftsm cigna facility · percent of total billed charges · outpatientfrom % of charges | $277 | $277 | — | — | — | $277 – $277 |
| 4 | Humana hb ftsm humana facility · percent of total billed charges · outpatientfrom % of charges | $416 | $416 | — | — | — | $416 – $416 |
| 5 | Aetna hb ftsm managed medicare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 6 | Blue Cross Blue Shield hb ftsm managed medicare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 7 | First Health hb ftsm managed medicare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 8 | Humana hb ftsm humana mcr facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 9 | Medica hb ftsm managed medicare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 10 | Medicare hb ftsm medicare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 11 | Tricare hb ftsm tricare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 12 | UnitedHealthcare hb ftsm managed medicare facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 13 | UnitedHealthcare hb ftsm uhc mcr 100% facility · fee schedule · outpatient | $420 | $420 | — | — | — | $420 – $420 |
| 14 | First Health hb ftsm first health_ccn facility · percent of total billed charges · outpatientfrom % of charges | $428 | $428 | — | — | — | $428 – $428 |
| 15 | WellCare hb ftsm novasys mcr 103% facility · fee schedule · outpatient | $433 | $433 | — | — | — | $433 – $433 |
| 16 | Devoted hb ftsm devoted health mcr facility · fee schedule · outpatient | $438 | $438 | — | — | — | $438 – $438 |
| 17 | Cigna hb ftsm healthspring cigna mcr 105% facility · fee schedule · outpatient | $442 | $442 | — | — | — | $442 – $442 |
| 18 | Aetna hb ftsm coventry/aetna facility · percent of total billed charges · outpatientfrom % of charges | $443 | $443 | — | — | — | $443 – $443 |
| 19 | MultiPlan hb ftsm,wldar,ozkar,prsar multi plan facility · percent of total billed charges · outpatientfrom % of charges | $471 | $471 | — | — | — | $471 – $471 |
| 20 | Ambetter hb ftsm novasys ambetter exchange facility · fee schedule · outpatient | $600 | $600 | — | — | — | $600 – $600 |
Last updated: Jun 8, 2026
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