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
Belt Si Loc Sm/Med
Smith, AR
See all hospitals reporting HCPCS L0625 →Price type
Mercy Hospital Fort Smith’s median price of $32 is 28% below the median hospital's median price ($45), higher than 18% of the 1,249 hospitals reporting HCPCS L0625. 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 | Ambetter hb ftsm novasys ambetter exchange facility · percent of total billed charges · outpatientfrom % of charges | $5 | $5 | — | — | — | $5 – $5 |
| 2 | Aetna hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $7 | $7 | $4 | 51% | — | $4 – $14 |
| 3 | Humana hb ftsm ok managed medicaid facility · percent of total billed charges · outpatientfrom % of charges | $7 | $7 | $4 | 51% | — | $4 – $14 |
| 4 | Humana hb ftsm humana facility · percent of total billed charges · outpatientfrom % of charges | $21 | $22 | $11 | 51% | — | $11 – $42 |
| 5 | First Health hb ftsm first health_ccn facility · percent of total billed charges · outpatientfrom % of charges | $22 | $23 | $12 | 51% | — | $11 – $43 |
| 6 | Aetna hb ftsm coventry/aetna facility · percent of total billed charges · outpatientfrom % of charges | $22 | $24 | $12 | 51% | 9–90 | $11 – $45 |
| 7 | MultiPlan hb ftsm,wldar,ozkar,prsar multi plan facility · percent of total billed charges · outpatientfrom % of charges | $24 | $25 | $13 | 51% | — | $12 – $48 |
| 8 | Aetna hb ftsm managed medicare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 9 | Blue Cross Blue Shield hb ftsm managed medicare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 10 | First Health hb ftsm managed medicare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 11 | Humana hb ftsm humana mcr facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 12 | Medica hb ftsm managed medicare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 13 | Medicare hb ftsm medicare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 14 | Tricare hb ftsm tricare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 15 | UnitedHealthcare hb ftsm managed medicare facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 16 | UnitedHealthcare hb ftsm uhc mcr 100% facility · fee schedule · outpatient | $42 | $42 | — | — | — | $42 – $42 |
| 17 | WellCare hb ftsm novasys mcr 103% facility · fee schedule · outpatient | $43 | $43 | — | — | — | $43 – $43 |
| 18 | Devoted hb ftsm devoted health mcr facility · fee schedule · outpatient | $44 | $44 | — | — | — | $44 – $44 |
| 19 | Cigna hb ftsm healthspring cigna mcr 105% facility · fee schedule · outpatient | $44 | $44 | — | — | — | $44 – $44 |
| 20 | Ambetter hb ftsm novasys ambetter exchange facility · fee schedule · outpatient | $60 | $60 | — | — | — | $60 – $60 |
Last updated: Jun 8, 2026
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