RC 404
Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
PET IMAGE W/CT FULL BODY
Kyle, TX
See all hospitals reporting RC 404 →Price type
Ascension Seton’s median price of $5.3k is 77% above the median hospital's median price ($3.0k), higher than 86% of the 1,496 hospitals reporting RC 404. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 12 payers, 82 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Oscar 4511_oscar health plan 20251001 per diem · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 2 | UnitedHealthcare 4501_united healthcare nexus city hmo (aus,nw,sw,bas) 20250701 case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 3 | UnitedHealthcare 4503_united healthcare nexus city hmo (wil,hays) 20250701 case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 4 | UnitedHealthcare 4504_united healthcare nexus city ppo (aus,nw,sw,bas) 20250401 case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 5 | UnitedHealthcare 4506_united healthcare nexus city ppo (wil,hays) 20250701 case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 6 | UnitedHealthcare 4507_united healthcare standard nexus aco (aus,nw,sw,bas) 20250701 case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 7 | UnitedHealthcare 4509_united healthcare standard nexus aco (wil,hays) 20250701 case rate · outpatient | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 8 | Blue Cross Blue Shield 4093_blue cross blue shield bav exchange (chi,dcn) 20250101 percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.4k | $262 | 11% | — | $1.8k – $2.7k |
| 9 | Aetna 1377_aetna hmo exchange 20200101 case rate · outpatient | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 10 | UnitedHealthcare 4498_united healthcare (aus,nw,sw, bas) 20250701 per diem · outpatient | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 11 | UnitedHealthcare 4500_united healthcare (wil,hays) 20250701 per diem · outpatient | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 12 | Superior Healthplan 3509_chirp superior star (chi,dcn) inpatient 20240901 percent of total billed charges · bothfrom % of charges | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 13 | Superior Healthplan 3512_chirp superior star (hay) inpatient 20240901 percent of total billed charges · bothfrom % of charges | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 14 | Superior Healthplan 4375_chirp superior star plus (chi,dcn) inpatient 20240901 percent of total billed charges · bothfrom % of charges | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 15 | Superior Healthplan 4378_chirp superior star plus (hay) inpatient 20240901 percent of total billed charges · bothfrom % of charges | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 16 | Aetna 235_aetna pos 20140601 case rate · outpatient | $3.1k | $3.1k | — | — | — | $3.1k – $3.1k |
| 17 | Aetna 236_aetna elect choice 20140601 case rate · outpatient | $3.1k | $3.1k | — | — | — | $3.1k – $3.1k |
| 18 | Blue Cross Blue Shield 4095_blue cross blue shield hmo essentials 20250101 percent of total billed charges · outpatientfrom % of charges | $3.2k | $3.2k | — | — | — | $3.2k – $3.2k |
| 19 | Aetna 3438_aetna aco ppo 20240701 percent of total billed charges · outpatientfrom % of charges | $3.4k | $3.3k | $362 | 11% | — | $2.4k – $3.7k |
| 20 | Aetna 249_aetna ppo exchange 20140101 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.4k | $369 | 11% | — | $2.5k – $3.8k |
| 21 | Blue Cross Blue Shield 4094_blue cross blue shield ppo 20250101 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 22 | Humana 387_humana exchange 20160101 percent of total billed charges · outpatientfrom % of charges | $4.0k | $3.9k | $423 | 11% | — | $2.8k – $4.3k |
| 23 | Aetna 4488_aetna ppo 20250801 percent of total billed charges · outpatientfrom % of charges | $4.1k | $4.0k | $431 | 11% | — | $2.9k – $4.4k |
| 24 | Humana 206_humana hmo custom 20140201 percent of total billed charges · outpatientfrom % of charges | $4.3k | $4.1k | $446 | 11% | — | $3.0k – $4.6k |
| 25 | Aetna 551_aetna hmo exchange (chi,dcn) 20170415 percent of total billed charges · outpatientfrom % of charges | $4.3k | $4.2k | $454 | 11% | — | $3.0k – $4.7k |
Last updated: Jan 1, 2026
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