Does Mercy Hospital Fort Smith have an emergency room?

Yes. Medicare (CMS) data lists emergency services at Mercy Hospital Fort Smith. In a medical emergency, call 911.

Where is Mercy Hospital Fort Smith?

7301 Rogers Ave, Fort Smith, AR 72903, in Sebastian County, Arkansas.

What is the phone number of Mercy Hospital Fort Smith?

(479) 314-6000, as listed by Medicare (CMS).

What is the Medicare star rating of Mercy Hospital Fort Smith?

3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Mercy Hospital Fort Smith — Fort Smith, AR

Quick answers

Does Mercy Hospital Fort Smith have an emergency room?: Yes. Medicare (CMS) data lists emergency services at Mercy Hospital Fort Smith. In a medical emergency, call 911.
Where is Mercy Hospital Fort Smith?: 7301 Rogers Ave, Fort Smith, AR 72903, in Sebastian County, Arkansas.
What is the phone number of Mercy Hospital Fort Smith?: (479) 314-6000, as listed by Medicare (CMS).
What is the Medicare star rating of Mercy Hospital Fort Smith?: 3 out of 5 stars in the CMS overall hospital quality rating (CMS data updated 2026-07-22).

Specialties and care areas^[4]

Treatments^[4]

Radiation therapy
Hospice care
Home care
Wound care
Hyperbaric medicine
Robotic-assisted general surgery
Robotic-assisted gynecologic surgery
Robotic-assisted urologic surgery

Procedures^[4]

Robotic-assisted surgery (general, gynecologic, urologic)
Digital mammography
Labor and delivery
Diagnostic and outpatient testing

Programs and centers^[4]

Birthplace (childbirth center)
Level IIIA NICU
Breast Center
Sleep disorder center
Wound care clinic with hyperbaric medicine
Outpatient surgery center
Women's Center

Emergency care (hospital website)^[4][5]

Emergency room	Yes
Trauma designation	Level III

Visiting and practical information

Visiting	Open visiting 24/7; ICU two visitors at a time; NICU limited to two designated people^[4]
Interpreters and languages	Free language interpreters and translation services available to patients when needed^[4]

Doctors and clinicians (711)

711 doctors and other clinicians list Mercy Hospital Fort Smith as a hospital where they work, in Medicare's official clinician data (updated 2026-10-02). It is not a complete staff list.

Main specialties

Doctors with a page on this site (711)

Aaron E. White, MDFamily Practice
Aaron M. Lawrence, DOEmergency Medicine
Aaron W. Bull, MDEmergency Medicine
Abdul-Nasser Adjei, MDCardiovascular Disease (Cardiology)
Adam C. Gold, MDDiagnostic Radiology
Adebayo Fasanya, MDPulmonary Disease
Adeel Shamim, MDGeneral Surgery
Adriel J. Schmitt, CNACertified Registered Nurse Anesthetist (CRNA)
Ahmed Abdelkader, MDNeurology
Alan L. Diamond, DONeurology
Alanna Barfoot, DOFamily Practice
Alejandro D. Castellvi, MDNeurosurgery
Alesia J. Davis, NPNurse Practitioner
Alex Eduardo Calderon Rodriguez, MDNephrology
Ali Dakka, MDEmergency Medicine
Alicia Schlesier, NPNurse Practitioner
Allen L. Beachy, MDFamily Practice
Allison Tanck, MDGeneral Surgery
Amanda D. Combs, NPNurse Practitioner
Amanda English, NPNurse Practitioner
Amanda G. Chisum Price, MDGeneral Surgery
Amanda G. Garretson, NPNurse Practitioner
Amanda L. Cole, NPNurse Practitioner
Amanda L. McClure, NPNurse Practitioner

And 687 more: the button below opens the full list.

Other emergency rooms nearby

Hospitals that list emergency services, by straight-line distance (not driving distance).

Baptist Health - Fort Smith4.2 mi · Fort Smith, AR · Acute Care Hospital
Baptist Health - Van Buren5.8 mi · Van Buren, AR · Acute Care Hospital
Eastern Oklahoma Medical Center26 mi · Poteau, OK · Critical Access Hospital
Sequoyah County-City of Sallisaw Hospital Authorit…26 mi · Sallisaw, OK · Acute Care Hospital
Mercy Hospital Booneville28 mi · Booneville, AR · Critical Access Hospital

Other hospitals nearby

Arkansas Extended Care Hospital-Ft Smith0.0 mi · Fort Smith, AR · Long-Term Acute Care Hospital
Valley Behavioral Health System2.1 mi · Barling, AR · Psychiatric Hospital
Mercy Rehabilitation Hospital3.1 mi · Fort Smith, AR · Inpatient Rehabilitation Hospital
Encompass Health Rehabilitation Hospital Ft Smith4.0 mi · Fort Smith, AR · Inpatient Rehabilitation Hospital

Nursing homes, hospice, home health and dialysis nearby

Medicare-certified providers within 25 miles, by straight-line distance. Hospice and home health care is given at home: their address is the office.

Nursing homes

Methodist Health and Rehab0.7 mi · Fort Smith, AR · 3 of 5 stars
Chapel Ridge Health and Rehab1.9 mi · Fort Smith, AR · 4 of 5 stars
Covington Court Health and Rehabilitation Center2.5 mi · Fort Smith, AR · 5 of 5 stars

All nursing homes in the state →

Hospice providers

Heart of Hospice, LLC0.5 mi · Fort Smith, AR · 3 of 5 stars
Mercy Hospice0.5 mi · Fort Smith, AR · 3 of 5 stars
Area Agency on Aging of Western Arkansas Inc3.6 mi · Fort Smith, AR

All hospice providers in the state →

Home health agencies

Access Home Health0.5 mi · Fort Smith, AR · 3 of 5 stars
Kindred at Home 10.5 mi · Fort Smith, AR · 4 of 5 stars
Area Agency on Aging of Western Arkansas, Inc.3.6 mi · Fort Smith, AR

All home health agencies in the state →

Dialysis facilities

Ft Smith Regional Dialysis Ctr4.4 mi · Fort Smith, AR · 1 of 5 stars
Van Buren Dialysis Center8.0 mi · Van Buren, AR · 2 of 5 stars

All dialysis facilities in the state →

Outpatient surgery centers nearby

Medicare-certified ambulatory surgery centers within 25 miles, by straight-line distance.

Executive Park Surgery Center0.5 mi · Fort Smith, AR
Fort Smith Ambulatory Surgery Center LLC0.5 mi · Fort Smith, AR
Massard Ambulatory Surgery Center LLC0.5 mi · Fort Smith, AR

All outpatient surgery centers in the state →

Community care nearby

Health centers, clinics, urgent care and pharmacies closest to this hospital, by straight-line distance, from official HRSA, Medicare and NPI Registry data. In a medical emergency, call 911.

Community health centers

ARCARE1590.5 mi · Fort Smith, AR · Community health center
Eastside Family Clinic1.0 mi · Fort Smith, AR · Community health center
RVPCS - Northside Clinic3.7 mi · Fort Smith, AR · Community health center

Clinics and urgent care

Medexpress Urgent Care Arkansas, P.A.0.5 mi · Fort Smith, AR · Urgent care center
PMC Services LLC5.7 mi · Fort Smith, AR · Urgent care center
Baptist Health Family Clinic - Alma12 mi · Alma, AR · Rural health clinic

Pharmacies

Laws Drug Co Inc0.5 mi · Fort Smith, AR · Community/retail pharmacy
Maybranch Pharmacy0.5 mi · Fort Smith, AR · Pharmacy
Medisav Homecare Pharmacies Inc0.5 mi · Fort Smith, AR · Community/retail pharmacy

About the Medicare star rating

CMS (the federal Medicare agency) gives many hospitals an overall rating from 1 to 5 stars, based on measures of mortality, safety, readmissions, patient experience and timely care. It is one piece of information: ask your doctor what matters for your care. See the full Medicare profile →

Medicare quality data

What Mercy Hospital Fort Smith reported to Medicare (CMS), the federal agency that publishes these results for hospitals nationwide. These are averages for many patients, not a prediction for any one person: ask your doctor what matters for your care. In a medical emergency, call 911.

What patients said (patient survey)

What this means: Patients who stayed overnight answered a national survey (HCAHPS) about their stay. More stars mean patients reported a better experience than at other hospitals. The percentages show how often patients gave the best answer, next to the national average.

Summary star rating (all survey topics)	3 of 5 stars
Overall rating of the hospital	3 of 5 stars
Would recommend the hospital	4 of 5 stars
Nurses communicated well	4 of 5 stars
Doctors communicated well	2 of 5 stars
Staff explained medicines	2 of 5 stars
Information about recovery at home	2 of 5 stars
Room and bathroom kept clean	4 of 5 stars
Quiet at night	4 of 5 stars
Rated the hospital 9 or 10 out of 10	70%National average: 72%
Would definitely recommend the hospital	76%National average: 71%
Nurses “always” communicated well	78%National average: 80%
Doctors “always” communicated well	74%National average: 80%
Staff “always” explained medicines before giving them	54%National average: 62%
Were given information about recovery at home	82%National average: 86%
Room and bathroom “always” clean	73%National average: 74%
Area around the room “always” quiet at night	58%National average: 60%
Completed surveys	459Response rate: 19%

Source: Patient survey (HCAHPS) - Hospital — CMS, released July 22, 2026; patients discharged October 2024 to September 2025.

Infections caught in the hospital

What this means: CMS compares the number of infections patients caught in this hospital with the number expected for a hospital like it. The number shown is that ratio: below 1 means fewer infections than expected, above 1 means more. “Better” or “worse” is shown only when the difference is clear in the data.

Central line bloodstream infections (CLABSI)	0.481No different from the national benchmark
Catheter-associated urinary tract infections (CAUTI)	0.651No different from the national benchmark
Surgical site infections after colon surgery	0.779No different from the national benchmark
Surgical site infections after abdominal hysterectomy	Not reported to Medicare
MRSA bloodstream infections	0.767No different from the national benchmark
Clostridioides difficile (C. diff) intestinal infections	0.163Better than the national benchmark

Source: Healthcare Associated Infections - Hospital — CMS, released July 22, 2026; data from October 2024 to September 2025.

Complications and deaths

What this means: Death rates are the share of patients who died within 30 days of going into the hospital for that condition, adjusted for how sick they were. PSI-90 combines several serious complications (a lower number is better). “No different from the national rate” is the most common result and means the hospital is in line with hospitals nationwide.

Deaths within 30 days: heart attack patients	12%
Deaths within 30 days: heart failure patients	11.2%
Deaths within 30 days: pneumonia patients	17.2%
Deaths within 30 days: COPD patients	8.3%
Deaths within 30 days: stroke patients	10.5%
Deaths within 30 days: coronary bypass surgery (CABG)	3.3%
Serious complications (patient safety indicator PSI-90)	0.69No different from the national rate
Complications after hip or knee replacement	3.1%

Source: Complications and Deaths - Hospital — CMS, released September 10, 2026; data from July 2022 to June 2025.

Return visits to the hospital (readmissions)

What this means: The share of patients who had to be admitted to a hospital again within 30 days after going home, adjusted for how sick they were. A lower percentage is better.

Returned to any hospital within 30 days (all patients)	Not reported to Medicare
Readmitted within 30 days: heart attack	14.1%
Readmitted within 30 days: heart failure	22.5%
Readmitted within 30 days: pneumonia	17.6%
Readmitted within 30 days: COPD	20.5%
Readmitted within 30 days: coronary bypass surgery	11.7%
Readmitted within 30 days: hip or knee replacement	6%

Source: Unplanned Hospital Visits - Hospital — CMS, released September 10, 2026; data from July 2023 to June 2025.

Emergency room times and sepsis care

What this means: ER time is the middle (median) time from arriving at the emergency room to leaving it; busier ERs usually have longer times, so the ER volume is shown too. Leaving before being seen: a lower percentage is better. Sepsis is a life-threatening reaction to an infection; a higher percentage means more patients got every recommended early step.

Emergency room volume (patients per year)	Very high (60,000 or more)
Average (median) time patients spent in the emergency room before leaving (OP-18b)	228 minutesNational average: 162 minutes
Patients who left the emergency room before being seen (OP-22)	3%National average: 2%
Sepsis patients who got all the recommended early care (SEP-1)	68%National average: 65%

Source: Timely and Effective Care - Hospital — CMS, released July 22, 2026; data from January 2024 to December 2024.

See every measure on Medicare Care Compare →

ER wait times and Medicare ratings nearby

How this hospital compares with others in the area, ranked only by official Medicare (CMS) numbers.

ER wait times in Fort Smith Best hospitals in Arkansas

Prices

Every US hospital must publish its standard charges in a file that follows a federal (CMS) format. Below are 65 common services exactly as Mercy Hospital Fort Smith lists them in its file. This is not a quote: what you pay depends on your insurance and plan, the doctors involved and the care you actually receive. Prices change: ask the hospital for an estimate before you schedule care (if you are uninsured or paying yourself, you have the right to a written “good faith estimate”). In a medical emergency, call 911.

What the prices mean

Hospital charge: The hospital’s list price (“gross charge”) before any discount or insurance. Few people pay this amount.
Cash price: The price the hospital offers if you pay yourself, without insurance (“discounted cash price”).
Insurance rates: The lowest and highest amounts the hospital has agreed with any insurance plan for the service (“de-identified minimum and maximum”), and some of the rates it lists by insurer and plan. Your share depends on your deductible, copay and coinsurance.
Hospital and doctor fees: A service can have a hospital (facility) fee and a separate doctor (professional) fee; the total for your care can include both, plus other services.

How to use hospital prices: estimates, financial assistance and your rights →

$ 3 amounts are marked with “!”: they are more than 100 times higher or lower than what other hospitals list for the same service, which usually means an error or a different unit in the hospital’s file. They are shown exactly as listed; ask the hospital before relying on them.

Office and emergency visits

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III New Pt Mlp	$112	$72.80	$66.15 – $170.64
New patient office visit (about 30–44 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $56 AETNA [20008] — HB FTSM COVENTRY/AETNA: $89.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $89.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $66.15 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $28 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $28 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $107.39 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $107.39 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $66.15
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III New Pt Pf	$131	$85.15	$5 – $11.35
New patient office visit (about 30–44 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $65.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $104.80 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $104.80 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $66.15 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $32.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $32.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $107.39 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $107.39 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $66.15
New patient office visit (about 30–44 minutes) CPT 99203 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level III New Patient	$330	$214.50	$562
New patient office visit (about 30–44 minutes): 10 of 112 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $165 AETNA [20008] — HB FTSM COVENTRY/AETNA: $264 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $264 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $98.08 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $66.15 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $82.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $82.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $107.39 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $107.39 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $66.15
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV New Pt Mlp	$152	$98.80	$33.47 – $129.20
New patient office visit (about 45–59 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $76 AETNA [20008] — HB FTSM COVENTRY/AETNA: $121.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $121.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $108.36 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $38 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $38 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $173.64 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $173.64 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $108.36
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV New Pt Pf	$178	$115.70	$108.36 – $258.45
New patient office visit (about 45–59 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $89 AETNA [20008] — HB FTSM COVENTRY/AETNA: $142.40 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $142.40 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $108.36 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $44.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $44.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $173.64 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $173.64 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $108.36
New patient office visit (about 45–59 minutes) CPT 99204 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV New Pt	$431	$280.15	$94.91 – $366.35
New patient office visit (about 45–59 minutes): 10 of 112 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $215.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $344.80 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $344.80 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $147.66 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $108.36 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $107.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $107.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $173.64 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $173.64 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $108.36
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level V New Patient	$530	$344.50	$562
New patient office visit (about 60–74 minutes): 10 of 123 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $265 AETNA [20008] — HB FTSM COVENTRY/AETNA: $424 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $424 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $147.94 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $132.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $132.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $235.61 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $235.61 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $147.94
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level V New Pt Pf	$278	$180.70	$61.22 – $236.30
New patient office visit (about 60–74 minutes): 10 of 123 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $139 AETNA [20008] — HB FTSM COVENTRY/AETNA: $222.40 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $222.40 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $147.94 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $69.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $69.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $235.61 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $235.61 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $147.94
New patient office visit (about 60–74 minutes) CPT 99205 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level V New Pt Mlp	$237	$154.05	$52.19 – $201.45
New patient office visit (about 60–74 minutes): 10 of 123 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $118.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $189.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $189.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $194.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $147.94 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $59.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $59.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $235.61 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $235.61 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $147.94
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: L&D Level II, 18-24 Hrs	$1,497	$973.05	$12.80 – $29.05
Established patient office visit (about 20–29 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $748.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,197.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,197.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $53.67 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $374.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $374.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $86.27 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $86.27 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $53.67
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: L&D Level II, 0-6 Hrs	$654	$425.10	$12.80 – $29.05
Established patient office visit (about 20–29 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $327 AETNA [20008] — HB FTSM COVENTRY/AETNA: $523.20 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $523.20 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $53.67 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $163.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $163.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $86.27 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $86.27 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $53.67
Established patient office visit (about 20–29 minutes) CPT 99213 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: L&D Level II, 12-18 Hrs	$1,155	$750.75	$254.33 – $981.75
Established patient office visit (about 20–29 minutes): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $577.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $924 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $924 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $79.99 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $53.67 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $288.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $288.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $86.27 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $86.27 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $53.67
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV Est Pt Pf	$142	$92.30	$5 – $11.35
Established patient office visit (about 30–39 minutes): 10 of 123 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $71 AETNA [20008] — HB FTSM COVENTRY/AETNA: $113.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $113.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $78.89 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $35.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $35.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $127.54 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $127.54 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $78.89
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: OP Visit Level IV Est Pt Mlp	$121	$78.65	$26.64 – $102.85
Established patient office visit (about 30–39 minutes): 10 of 123 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $60.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $96.80 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $96.80 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $78.89 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $30.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $30.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $127.54 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $127.54 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $78.89
Established patient office visit (about 30–39 minutes) CPT 99214 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lactation Consult 46-60 Minutes	$213	$138.45	$46.90 – $181.05
Established patient office visit (about 30–39 minutes): 10 of 113 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $106.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $170.40 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $170.40 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $113.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $78.89 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $53.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $53.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $127.54 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $127.54 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $78.89
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: New/Est Office/OP Cnslt Low 30-39 Min Pf	$120	$78	$5 – $11.35
Office consultation with a specialist (moderate): 10 of 76 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $60 AETNA [20008] — HB FTSM COVENTRY/AETNA: $96 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $96 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $30 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $30 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $30 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $46.37 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $46.37 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $5 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $11.35
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: New/Est Office/OP Cnslt Low 30-39 Min Mlp	$102	$66.30	$22.46 – $86.70
Office consultation with a specialist (moderate): 10 of 71 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $51 AETNA [20008] — HB FTSM COVENTRY/AETNA: $81.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $81.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $25.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $25.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $25.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $39.41 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $39.41 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $5 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $11.35
Office consultation with a specialist (moderate) CPT 99243 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: New/Est Office/OP Cnslt Low 30-39 Min	$167	$108.55	$136.66
Office consultation with a specialist (moderate): 10 of 61 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $83.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $133.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $133.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $41.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $41.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $41.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $64.53 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $64.53 AUXIANT CONTRACTED [320462] — HB FTSM NET AFFILIATION: $108.55 AUXIANT CONTRACTED [320462] — HB FTSM ROGR DEC BUCHHEIT: $100.20
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: New/Est Office/OP Cnslt Mod 40-54 Min Pf	$143	$92.95	$78.89 – $194.49
Office consultation with a specialist (moderate to high): 10 of 76 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $71.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $114.40 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $114.40 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $35.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $35.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $35.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $55.26 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $55.26 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $5 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $11.35
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: New/Est Office/OP Cnslt Mod 40-54 Min Mlp	$122	$79.30	$194.49
Office consultation with a specialist (moderate to high): 10 of 71 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $61 AETNA [20008] — HB FTSM COVENTRY/AETNA: $97.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $97.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $30.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $30.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $30.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $47.14 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $47.14 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $5 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $11.35
Office consultation with a specialist (moderate to high) CPT 99244 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: New/Est Office/OP Cnslt Mod 40-54 Min	$208	$135.20	$45.80 – $176.80
Office consultation with a specialist (moderate to high): 10 of 61 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $104 AETNA [20008] — HB FTSM COVENTRY/AETNA: $166.40 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $166.40 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $52 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $52 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $52 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $80.37 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $80.37 AUXIANT CONTRACTED [320462] — HB FTSM NET AFFILIATION: $135.20 AUXIANT CONTRACTED [320462] — HB FTSM ROGR DEC BUCHHEIT: $124.80
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 3	$1,993.50	$1,295.77	$64 – $735
Emergency room visit (moderate): 10 of 126 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $854 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $854 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $246.57 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $259.38 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $735 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $733 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $370.16 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $370.16 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $259.38 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250
Emergency room visit (moderate) CPT 99283 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Non Emergent Medicaid Level 3	$1,484	$964.60	$259.38 – $427.98
Emergency room visit (moderate): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $742 AETNA [20008] — HB FTSM COVENTRY/AETNA: $854 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $854 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $246.57 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $259.38 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $371 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $371 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $370.16 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $370.16 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $259.38
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 4	$3,596	$2,337.40	$733 – $1,300
Emergency room visit (moderately high): 10 of 126 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,042.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $854 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $854 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $379.20 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $396.47 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $735 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $733 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $565.81 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $565.81 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $396.47
Emergency room visit (moderately high) CPT 99284 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Non Emergency Medicaid Level 4	$2,085	$1,355.25	$1,306
Emergency room visit (moderately high): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,042.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $854 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $854 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $379.20 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $396.47 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $521.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $521.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $565.81 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $565.81 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $396.47
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: ED Visit Care Level 5	$3,084	$2,004.60	$51 – $2,100
Emergency room visit (high): 10 of 126 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $854 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $854 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $545.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $565.86 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $733 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $733 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $807.54 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $807.54 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $565.86 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $51
Emergency room visit (high) CPT 99285 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Non Emergency Medicaid Level 5	$3,084	$2,004.60	$1,466
Emergency room visit (high): 10 of 122 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,542 AETNA [20008] — HB FTSM COVENTRY/AETNA: $854 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $854 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $545.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $565.86 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $771 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $771 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $807.54 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $807.54 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $565.86

Lab tests

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Basic metabolic panel (blood test) CPT 80048 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Basic Metabolic Pnl Calcium Total	$29	$18.85	$6.39 – $24.65
Basic metabolic panel (blood test): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $14.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $11.54 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $11.54 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $7.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $8.30 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $11.60 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $11.60 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $11.84 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $11.84 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $8.30
Comprehensive metabolic panel (blood test) CPT 80053 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comprehensive Metabolic Panel	$36	$23.40	$9.39 – $48.24
Comprehensive metabolic panel (blood test): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $18 AETNA [20008] — HB FTSM COVENTRY/AETNA: $14.41 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $14.41 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $9.39 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $10.36 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $14.49 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $14.49 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $14.78 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $14.78 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $10.36
Obstetric blood test panel CPT 80055 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Obstetric Panel	$365	$237.25	$80.37 – $310.25
Obstetric blood test panel: 10 of 116 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $182.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $292 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $292 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $42.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $46.90 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $65.58 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $65.58 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $46.90 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $36.52 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $82.90
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lipid Panel	$138	$89.70	$30.39 – $117.30
Cholesterol panel (lipid panel): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $69 AETNA [20008] — HB FTSM COVENTRY/AETNA: $17.35 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $17.35 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $11.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $13.14 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $17.45 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $17.45 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $18.75 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $18.75 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $13.14
Cholesterol panel (lipid panel) CPT 80061 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Lipid Panel	$138	$89.70	$11.91 – $58.06
Cholesterol panel (lipid panel): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $69 AETNA [20008] — HB FTSM COVENTRY/AETNA: $17.35 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $17.35 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $11.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $13.14 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $17.45 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $17.45 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $18.75 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $18.75 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $13.14
Kidney function panel CPT 80069 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Renal Function Panel	$48	$31.20	$7.72 – $39.66
Kidney function panel: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $24 AETNA [20008] — HB FTSM COVENTRY/AETNA: $11.85 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $11.85 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $7.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $8.52 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $11.91 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $11.91 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $12.15 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $12.15 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $8.52
Liver function panel CPT 80076 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hepatic Function Panel	$34	$22.10	$7.27 – $37.29
Liver function panel: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $17 AETNA [20008] — HB FTSM COVENTRY/AETNA: $11.14 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $11.14 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $7.27 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $8.01 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $11.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $11.21 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $11.44 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $11.44 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $8.01
Urine test (automated, with microscope) CPT 81001 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Automated W Micro	$17	$11.05	$2.82 – $14.46
Urine test (automated, with microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $8.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $4.32 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $4.32 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3.11 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $4.35 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $4.35 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.44 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.44 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3.11
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Urinalysis Non-Auto	$18	$11.70	$3.10 – $11.68
Urine test (manual, without microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $9 AETNA [20008] — HB FTSM COVENTRY/AETNA: $3.49 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $3.49 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3.41 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.87 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.87 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3.41
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Non Automated WO Micro	$31	$20.15	$3.10 – $11.68
Urine test (manual, without microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $15.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $3.49 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $3.49 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3.41 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.87 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.87 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3.41
Urine test (manual, without microscope) CPT 81002 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ph Nonautomated	$62	$40.30	$13.65 – $52.70
Urine test (manual, without microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $31 AETNA [20008] — HB FTSM COVENTRY/AETNA: $3.49 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $3.49 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3.41 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.87 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4.87 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3.41
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Specific Gravity Urine Automated	$67	$43.55	$2 – $10.24
Urine test (automated, without microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $33.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $3.06 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $3.06 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $2.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3.08 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3.08 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3.15 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3.15 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $2.21
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urine Ph Automated	$53	$34.45	$2 – $10.24
Urine test (automated, without microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $26.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $3.06 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $3.06 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $2.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3.08 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3.08 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3.15 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3.15 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $2.21
Urine test (automated, without microscope) CPT 81003 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Urinalysis Automated W/O Micro	$12	$7.80	$2 – $10.24
Urine test (automated, without microscope): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $6 AETNA [20008] — HB FTSM COVENTRY/AETNA: $3.06 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $3.06 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $2.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3.08 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3.08 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3.15 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3.15 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $2.21
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Ultrasensitive	$212	$137.80	$16.36 – $83.96
PSA (prostate specific antigen) blood test: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $106 AETNA [20008] — HB FTSM COVENTRY/AETNA: $25.09 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $25.09 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $16.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $18.04 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $25.23 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $25.23 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $25.75 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $25.75 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $18.04
PSA (prostate specific antigen) blood test CPT 84153 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Psa Total Diagnostic	$101	$65.65	$16.36 – $83.96
PSA (prostate specific antigen) blood test: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $50.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $25.09 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $25.09 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $16.36 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $18.04 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $25.23 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $25.23 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $25.75 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $25.75 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $18.04
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tsh Newborn	$17	$11.05	$3.74 – $14.45
Thyroid stimulating hormone (TSH) test: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $8.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $22.93 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $22.93 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $14.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $16.48 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $23.05 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $23.05 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $23.52 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $23.52 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $16.48
Thyroid stimulating hormone (TSH) test CPT 84443 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tsh Thyroid Stimulating Hormone	$92	$59.80	$14.94 – $76.75
Thyroid stimulating hormone (TSH) test: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $46 AETNA [20008] — HB FTSM COVENTRY/AETNA: $22.93 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $22.93 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $14.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $16.48 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $23.05 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $23.05 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $23.52 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $23.52 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $16.48
Complete blood count (CBC) with differential CPT 85025 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc W Auto Diff	$27	$17.55	$5.95 – $22.95
Complete blood count (CBC) with differential: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $13.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $10.61 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $10.61 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $6.91 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $7.62 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $10.66 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $10.66 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $10.88 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $10.88 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $7.62
Complete blood count (CBC), automated CPT 85027 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Cbc Automated WO Diff	$22	$14.30	$5.75 – $29.56
Complete blood count (CBC), automated: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $11 AETNA [20008] — HB FTSM COVENTRY/AETNA: $8.83 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $8.83 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $5.75 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $6.35 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $8.87 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $8.87 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $9.06 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $9.06 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $6.35
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: POC Prothrombin Time	$53	$34.45	$11.67 – $45.05
Blood clotting time test (prothrombin time, PT): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $26.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $5.37 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $5.37 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $4.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $5.39 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $5.39 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $6.01 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $6.01 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $4.21
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time	$22	$14.30	$3.82 – $17.97
Blood clotting time test (prothrombin time, PT): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $11 AETNA [20008] — HB FTSM COVENTRY/AETNA: $5.37 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $5.37 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $4.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $5.39 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $5.39 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $6.01 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $6.01 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $4.21
Blood clotting time test (prothrombin time, PT) CPT 85610 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Prothrombin Time Mixing Test	$82	$53.30	$18.06 – $69.70
Blood clotting time test (prothrombin time, PT): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $41 AETNA [20008] — HB FTSM COVENTRY/AETNA: $5.37 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $5.37 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3.82 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $4.21 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $5.39 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $5.39 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $6.01 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $6.01 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $4.21
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ptt Mixing	$100	$65	$22.02 – $85
Blood clotting test (partial thromboplastin time, PTT): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $8.19 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $8.19 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $5.35 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $5.90 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $8.24 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $8.24 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8.41 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8.41 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $5.90
Blood clotting test (partial thromboplastin time, PTT) CPT 85730 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ptt Partial Thromboplastin Time	$41	$26.65	$5.35 – $27.41
Blood clotting test (partial thromboplastin time, PTT): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $20.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $8.19 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $8.19 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $5.35 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $5.90 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $8.24 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $8.24 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8.41 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8.41 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $5.90

Imaging (X-ray, CT, MRI, ultrasound, mammogram)

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
CT scan of the head or brain, without contrast CPT 70450 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Head/Brain WO Cont	$1,654	$1,075.10	$1,700
CT scan of the head or brain, without contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $827 AETNA [20008] — HB FTSM COVENTRY/AETNA: $907 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $907 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $93.30 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $99.34 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $413.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $413.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $99.34
MRI of the brain, before and after contrast CPT 70553 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Brain W/WO Cont	$4,501	$2,925.65	$1,251 – $1,885
MRI of the brain, before and after contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $2,250.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $280.12 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $331.49 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,125.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,125.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $473.07 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $473.07 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $331.49
Chest X-ray, 2 views CPT 71046 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Chest 2 Views	$409	$265.85	$82.69 – $136.44
Chest X-ray, 2 views: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $204.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $327.20 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $327.20 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $28.75 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $82.69 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $102.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $102.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $118.01 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $118.01 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $82.69
X-ray of the lower spine, at least 4 views CPT 72110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xr Spine Lumbar Min 4 Views	$517	$336.05	$99.34 – $163.91
X-ray of the lower spine, at least 4 views: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $258.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $46.94 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $46.94 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $44.16 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $99.34 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $129.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $129.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $99.34
MRI of the lower back (lumbar spine), without contrast CPT 72148 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Lumbar Spine WO Cont	$3,024	$1,965.60	$2,100
MRI of the lower back (lumbar spine), without contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,512 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $168.63 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $226.71 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $756 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $756 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $226.71
CT scan of the pelvis, with contrast CPT 72193 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Pelvis W Cont	$2,435	$1,582.75	$151.76 – $1,205.31
CT scan of the pelvis, with contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,217.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $907 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $907 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $158.53 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $166.66 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $608.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $608.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $237.84 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $237.84 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $166.66
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Extr Lwr Jt WO Cont Bi	$3,151	$2,048.15	$226.71 – $374.09
MRI of a leg joint (such as the knee), without contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,575.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $177.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $226.71 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $787.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $787.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $226.71
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Extr Lwr Jt WO Cont Lt	$2,100	$1,365	$120.47 – $1,470.99
MRI of a leg joint (such as the knee), without contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,050 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $177.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $226.71 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $525 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $525 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $226.71
MRI of a leg joint (such as the knee), without contrast CPT 73721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: MRI Extr Lwr Jt WO Cont Rt	$2,100	$1,365	$1,251 – $1,885
MRI of a leg joint (such as the knee), without contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $1,050 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,441 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $177.93 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $226.71 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $525 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $525 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $323.55 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $226.71
CT scan of the abdomen and pelvis, with contrast CPT 74177 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: CT Abd Pelvis With Contrast	$4,919	$3,197.35	$331.49 – $546.97
CT scan of the abdomen and pelvis, with contrast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $2,459.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $907 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $907 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $265.29 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $331.49 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,229.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,229.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $473.07 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $473.07 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $331.49
Ultrasound of the abdomen, complete CPT 76700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Abdomen Complete	$1,082	$703.30	$99.34 – $163.91
Ultrasound of the abdomen, complete: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $541 AETNA [20008] — HB FTSM COVENTRY/AETNA: $140.75 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $140.75 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $99.52 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $99.34 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $270.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $270.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $99.34
Pregnancy ultrasound (after the first trimester) CPT 76805 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Preg Uter 14 Wks Or>	$503	$326.95	$110.76 – $427.55
Pregnancy ultrasound (after the first trimester): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $251.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $135.30 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $135.30 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $94.70 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $99.34 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $125.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $125.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $99.34
Transvaginal ultrasound CPT 76830 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: US Transvaginal Non OB	$481	$312.65	$99.34 – $163.91
Transvaginal ultrasound: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $240.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $128.34 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $128.34 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $101.64 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $99.34 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $120.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $120.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $141.76 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $99.34
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Diagnostic Unilat Lt W Cad	$250	$162.50	$72.73 – $237.08
Diagnostic mammogram, one breast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $125 AETNA [20008] — HB FTSM COVENTRY/AETNA: $200 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $200 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $107.05 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $72.87 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $62.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $62.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $103.99 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $103.99 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $72.87
Diagnostic mammogram, one breast CPT 77065 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Diagnostic Unilat Rt W Cad	$250	$162.50	$72.73 – $237.08
Diagnostic mammogram, one breast: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $125 AETNA [20008] — HB FTSM COVENTRY/AETNA: $200 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $200 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $107.05 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $72.87 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $62.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $62.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $103.99 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $103.99 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $72.87
Diagnostic mammogram, both breasts CPT 77066 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Diagnostic Bilat W Cad	$270	$175.50	$93.26 – $297.92
Diagnostic mammogram, both breasts: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $135 AETNA [20008] — HB FTSM COVENTRY/AETNA: $216 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $216 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $135.41 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $93.40 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $67.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $67.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $133.29 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $133.29 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $93.40
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Scrn Left W Cad	$162	$105.30	$76.90 – $239.88
Screening mammogram, both breasts: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $81 AETNA [20008] — HB FTSM COVENTRY/AETNA: $129.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $129.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $109.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $77.11 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $40.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $40.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $110.04 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $110.04 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $77.11
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Scrn Right W Cad	$162	$105.30	$76.90 – $239.88
Screening mammogram, both breasts: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $81 AETNA [20008] — HB FTSM COVENTRY/AETNA: $129.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $129.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $109.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $77.11 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $40.50 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $40.50 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $110.04 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $110.04 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $77.11
Screening mammogram, both breasts CPT 77067 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Mamm Scrn Bilat Implant W Cad	$241	$156.65	$53.07 – $204.85
Screening mammogram, both breasts: 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $120.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $192.80 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $192.80 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $109.10 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $77.11 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $60.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $60.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $110.04 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $110.04 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $77.11

Heart tests and sleep study

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Left heart catheterization (diagnostic) CPT 93452 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lt Heart Cath Including Inj Lt Ventriculography, S/I	$8,267	$5,373.55	$5,877 – $8,632
Left heart catheterization (diagnostic): 10 of 120 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $4,133.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $6,972 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $6,972 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $749.56 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3,080.39 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $4,578 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $4,578 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,396.07 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,396.07 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3,080.39
Heart rhythm study (electrophysiology evaluation) CPT 93619 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comp Eval WO Induction	$11,367	$7,388.55	$5,877 – $12,196
Heart rhythm study (electrophysiology evaluation): 10 of 116 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $5,683.50 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $6,757.32 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $7,411.02 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $11,148 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $11,148 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $10,576.37 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $10,576.37 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $7,411.02 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $383 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $869.41
Heart rhythm study with ablation for atrial fibrillation CPT 93656 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Comp Ep Eval Pvi W/3d Mapping	$53,225	$34,596.25	$24,835.44 – $40,979.74
Heart rhythm study with ablation for atrial fibrillation: 10 of 116 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $26,612.50 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $817.30 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $24,835.44 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $13,306.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $13,306.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $35,443.03 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $35,443.03 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $24,835.44 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $530.95 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $1,205.26
Sleep study (overnight, in a sleep lab) CPT 95810 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Polysom Attended >3 Chn 6/> Yrs	$5,196	$3,377.40	$2,443
Sleep study (overnight, in a sleep lab): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $2,598 AETNA [20008] — HB FTSM COVENTRY/AETNA: $764.66 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $764.66 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $527.77 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $815.95 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,299 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,299 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,164.45 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,164.45 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $815.95

Physical therapy and mental health

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Ot Ther Exer 1 or > Area Ea 15m	$114	$74.10	$140 – $186
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $57 AETNA [20008] — HB FTSM COVENTRY/AETNA: $85.50 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $85.50 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $26.59 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $45.60 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $45.60 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $38.58 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $38.58 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $26.59
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Cpm Set Up Ea 15min	$127	$82.55	$168 – $186
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $63.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $95.25 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $95.25 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $26.59 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $50.80 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $50.80 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $38.58 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $38.58 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $26.59
Physical therapy: therapeutic exercise (each 15 minutes) CPT 97110 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Ther Exer 1 or > Area Ea 15m	$114	$74.10	$21.76 – $84.81
Physical therapy: therapeutic exercise (each 15 minutes): 10 of 124 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $57 AETNA [20008] — HB FTSM COVENTRY/AETNA: $85.50 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $85.50 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $25.94 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $26.59 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $45.60 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $45.60 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $38.58 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $38.58 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $26.59
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 105 Min	$392	$254.80	$86.32 – $333.20
Physical therapy evaluation (low complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $196 AETNA [20008] — HB FTSM COVENTRY/AETNA: $294 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $294 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $156.80 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $156.80 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 15 Min	$167	$108.55	$86.18 – $151.05
Physical therapy evaluation (low complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $83.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $125.25 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $125.25 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $66.80 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $66.80 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (low complexity) CPT 97161 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level I 150 Min	$520	$338	$168 – $186
Physical therapy evaluation (low complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $260 AETNA [20008] — HB FTSM COVENTRY/AETNA: $390 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $390 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $208 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $208 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 105 Min	$464	$301.60	$102.17 – $394.40
Physical therapy evaluation (moderate complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $232 AETNA [20008] — HB FTSM COVENTRY/AETNA: $348 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $348 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $185.60 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $185.60 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 135 Min	$542	$352.30	$168 – $186
Physical therapy evaluation (moderate complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $271 AETNA [20008] — HB FTSM COVENTRY/AETNA: $406.50 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $406.50 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $216.80 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $216.80 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (moderate complexity) CPT 97162 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level II 90 Min	$402	$261.30	$86.18 – $151.05
Physical therapy evaluation (moderate complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $201 AETNA [20008] — HB FTSM COVENTRY/AETNA: $301.50 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $301.50 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $160.80 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $160.80 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 150 Min	$549	$356.85	$120.89 – $466.65
Physical therapy evaluation (high complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $274.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $411.75 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $411.75 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $219.60 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $219.60 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 30 Min	$245	$159.25	$53.95 – $208.25
Physical therapy evaluation (high complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $122.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $183.75 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $183.75 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $98 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $98 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92
Physical therapy evaluation (high complexity) CPT 97163 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Pt Eval Level III 45 Min	$272	$176.80	$168 – $186
Physical therapy evaluation (high complexity): 10 of 114 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $136 AETNA [20008] — HB FTSM COVENTRY/AETNA: $204 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $204 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $88.72 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $89.92 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $108.80 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $108.80 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $131.46 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $89.92

Procedures and surgery

Service	Hospital charge	Cash price	Insurance rates (lowest – highest)
Shoulder arthroscopy: shaving of shoulder bone CPT 29826 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Surgical Arthroscopy Sho W/Coracoacrm Ligm Rls	$11,158.52	$7,253.04	$6,894.65 – $11,376.52
Shoulder arthroscopy: shaving of shoulder bone: 10 of 111 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $6,361.60 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $6,894.65 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3,834 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3,834 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $9,839.45 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $9,839.45 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $6,894.65 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $363 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $824.01 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $824.01
Knee arthroscopy: removal of torn cartilage (meniscus) CPT 29881 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Arthrs Knee Surg W/Meniscectomy Med/Lat W/Shvg	$7,059.99	$4,588.99	$297 – $5,515.84
Knee arthroscopy: removal of torn cartilage (meniscus): 10 of 111 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2,889.37 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3,108.96 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $3,834 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3,834 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,436.84 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,436.84 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3,108.96 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $297 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $674.19 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $674.19
Removal of tonsils and adenoids (under age 12) CPT 42820 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Tonsillectomy & Adenoidectomy <Age 12	$5,119.77	$3,327.85	$233.32 – $10,056.62
Removal of tonsils and adenoids (under age 12): 10 of 111 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $5,267.98 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $5,624.85 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,577 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8,027.31 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8,027.31 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $5,624.85 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $363 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $824.01 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $824.01
Upper GI endoscopy (diagnostic) CPT 43235 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Upper Endoscopy Complex	$5,570.04	$3,620.53	$100.39 – $1,575.27
Upper GI endoscopy (diagnostic): 10 of 124 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,778.40 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,778.40 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $555.75 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $861.79 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,268 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,268 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,229.88 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,229.88 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $861.79 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250
Upper GI endoscopy with biopsy CPT 43239 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Egd W/Biopsy Pf	$6,298.21	$4,093.84	$112.42 – $1,575.27
Upper GI endoscopy with biopsy: 10 of 107 insurance plan rates AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $861.79 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,268 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,268 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,229.88 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,229.88 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $861.79 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $297 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $674.19 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $674.19 BCBS MEDICARE ADVANTAGE [20047] — HB FTSM MANAGED MEDICARE: $861.79
Colonoscopy (diagnostic) CPT 45378 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Colonoscopy	$1,776	$1,154.40	$883.62 – $1,458.02
Colonoscopy (diagnostic): 10 of 124 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,420.80 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,420.80 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $444 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $883.62 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $444 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $444 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,261.03 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,261.03 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $883.62 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $11.20 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.)
Colonoscopy with biopsy CPT 45380 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Colo Biopsy Cold Pf	$5,133.97	$3,337.08	$161.84 – $2,078.35
Colonoscopy with biopsy: 10 of 107 insurance plan rates AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $1,137.01 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,268 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,268 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,622.65 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,622.65 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $1,137.01 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $567.50 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $567.50 BCBS MEDICARE ADVANTAGE [20047] — HB FTSM MANAGED MEDICARE: $1,137.01
Colonoscopy with removal of polyps (snare) CPT 45385 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: GI Colo Biopsy Snare Pf	$4,554.96	$2,960.72	$204.17 – $2,078.35
Colonoscopy with removal of polyps (snare): 10 of 107 insurance plan rates AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $1,137.01 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,268 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,268 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,622.65 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $1,622.65 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $1,137.01 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $567.50 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $567.50 BCBS MEDICARE ADVANTAGE [20047] — HB FTSM MANAGED MEDICARE: $1,137.01
Gallbladder removal by laparoscope CPT 47562 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Lap,Cholecystectomy Pf	$10,777.15	$7,005.15	$363 – $9,918.41
Gallbladder removal by laparoscope: 10 of 114 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $5,195.58 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $5,744.29 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $3,834 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8,197.76 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $8,197.76 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $5,744.29 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $363 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $824.01 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $824.01
Groin (inguinal) hernia repair, age 5 or older CPT 49505 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Rx Ing Hernia,5+Y/O,Reducibl Pf	$10,369.20	$6,739.98	$363 – $5,999.40
Groin (inguinal) hernia repair, age 5 or older: 10 of 111 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $3,142.68 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3,401.99 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,577 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,855.04 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,855.04 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3,401.99 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $363 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $824.01 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $824.01
Prostate biopsy CPT 55700 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Bx Prostate Needle/Punch	$12,328.21	$8,013.34	$250 – $1,824.23
Prostate biopsy: 10 of 113 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $2,028 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $2,028 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $1,824.23 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $340.59 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,268 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $340.59 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $567.50 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $567.50
Prostate removal by laparoscope (radical prostatectomy) CPT 55866 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laps Surg Prst8ect Rpbic Rad W/Nerve Sparing	$32,304.65	$20,998.02	$46 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) – $17,699.07
Prostate removal by laparoscope (radical prostatectomy): 10 of 113 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $1,056.31 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $10,100.16 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $12,562 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $12,562 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $14,414.09 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $14,414.09 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $10,100.16 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $46 (Far outside what other hospitals list for this service: probably an error in the hospital’s file. Ask the hospital.) ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $104.42 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $104.42
Hysteroscopy with biopsy of the uterus lining CPT 58558 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Hysteroscopy Bx Endometrium&/Polypc W/WO D&C	$7,695.49	$5,002.07	$183.86 – $3,536.99
Hysteroscopy with biopsy of the uterus lining: 10 of 110 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2,831.42 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $3,075.82 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,577 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,389.55 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $4,389.55 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $3,075.82 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $363 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $824.01 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $824.01
Spinal injection, lower back (epidural), with imaging guidance CPT 62323 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inject Interlaminar Lumbar or Sacral W Imag	$2,270.82	$1,476.03	$81.78 – $1,225.99
Spinal injection, lower back (epidural), with imaging guidance: 10 of 124 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $2,124.80 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $2,124.80 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $664 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $670.71 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $957.18 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $957.18 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $670.71 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $567.50 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $567.50
Nerve root injection, lower back, with imaging guidance CPT 64483 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Inj Transforminal Epi/Lumb/Sacral Sngl Level	$2,226.83	$1,447.44	$413.32 – $1,595.45
Nerve root injection, lower back, with imaging guidance: 10 of 124 insurance plan rates AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,501.60 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,501.60 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $469.25 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $840.40 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $469.25 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $469.25 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $725.27 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $725.27 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $840.40 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $250
Carpal tunnel release CPT 64721 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Neuroplas/ Tranposit Median Nerve at Carp Tiunn Pf	$3,579.73	$2,326.82	$1,855.42 – $3,061.54
Carpal tunnel release: 10 of 111 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $1,738.97 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $1,855.42 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,577 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $2,647.90 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $2,647.90 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $1,855.42 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $320 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $726.40 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $726.40
Laser treatment of clouding after cataract surgery CPT 66821 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Laser Yag Treatment	$1,275	$828.75	$297 – $674.19
Laser treatment of clouding after cataract surgery: 10 of 69 insurance plan rates 90 DEGREE BENEFITS CONTRACTED [320436] — HB FTSM DEC SHOW ME: $637.50 AETNA [20008] — HB FTSM COVENTRY/AETNA: $1,020 AETNA CONTRACTED [320008] — HB FTSM COVENTRY/AETNA: $1,020 AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $318.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $318.75 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $318.75 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $492.66 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $492.66 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $297 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $674.19
Cataract removal with lens implant CPT 66984 · Outpatient (no overnight stay) · Hospital (facility) fee In the file: Xcapsl Ctrc Rmvl Insj Io Lens Prosth W/O Ecp	$4,673.44	$3,037.74	$2,192.83 – $3,618.28
Cataract removal with lens implant: 10 of 111 insurance plan rates AETNA MEDICAID CONTRACTED [320009] — HB FTSM OK MANAGED MEDICAID: $2,031.02 AETNA MEDICARE ADVANTAGE CONTRACTED [320010] — HB FTSM MANAGED MEDICARE: $2,192.83 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC LACLEDE - NEW 07.01.25: $1,577 AITHER HEALTH CONTRACTED [320449] — HB FTSM DEC WOODARD: $1,577 AMBETTER [20452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3,129.42 AMBETTER CONTRACTED [320452] — HB FTSM NOVASYS AMBETTER EXCHANGE: $3,129.42 AMERICAN HEALTH ADVANTAGE OF MO MCR [20264] — HB FTSM MANAGED MEDICARE: $2,192.83 ARKANSAS DEPARTMENT OF HEALTH [20036] — HB FTSM ARK MEDICAID: $363 ARKANSAS TOTAL CARE [20039] — HB FTSM PASSE AR TOTAL CARE: $824.01 ARKANSAS TOTAL CARE CONTRACTED [320039] — HB FTSM PASSE AR TOTAL CARE: $824.01

Source: Mercy Hospital Fort Smith’s standard charges file (mercy.net, CSV, CMS template 3.0.0; it can be a very large file), last updated by the hospital on June 8, 2026; retrieved November 1, 2026. The hospital’s price transparency page →

Found through the hospital’s cms-hpt.txt file, as required by the federal hospital price transparency rule (CMS). We show a selection of common services; the file has every item and service.

Hospital information

Hospital type	Acute Care Hospital
Address	7301 Rogers Ave, Fort Smith, AR 72903
County	Sebastian County
State	Arkansas
Phone	(479) 314‑6000
Emergency services	Yes
Ownership	Voluntary non-profit - Private
Medicare overall rating	3 of 5 stars
Birthing-friendly designation	Yes (meets CMS criteria)
CMS Certification Number	040062
Name in Medicare records	MERCY HOSPITAL FORT SMITH
Profile level	Medicare data + hospital website
Official website	mercy.net
Corrections	Report an error or suggest an update →

Sources

Hospital General Information — Centers for Medicare & Medicaid Services (CMS), data updated 2026-07-22, retrieved 2026-10-29
Medicare Care Compare — official Medicare profile of this hospital
U.S. Census Bureau Geocoder — map position used for distances

From the hospital’s website

Numbers match the citations above. Checked 2026-10-30.

Mercy Hospital Fort Smith — mercy.net
Mercy Emergency Department - Fort Smith | Mercy — mercy.net

Mercy Hospital Fort Smith

Summary

Profile from official sources

At a glance