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
Rock, TX
See all hospitals reporting RC 404 →Price type
Ascension Seton’s median price of $4.1k is 37% above the median hospital's median price ($3.0k), higher than 71% of the 1,508 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: 11 payers, 66 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 | Blue Cross Blue Shield 4093_blue cross blue shield bav exchange (chi,dcn) 20250101 percent of total billed charges · outpatientfrom % of charges | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 2 | Aetna 3438_aetna aco ppo 20240701 percent of total billed charges · outpatientfrom % of charges | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 3 | Aetna 249_aetna ppo exchange 20140101 percent of total billed charges · outpatientfrom % of charges | $2.5k | $2.5k | — | — | — | $2.5k – $2.5k |
| 4 | Humana 387_humana exchange 20160101 percent of total billed charges · outpatientfrom % of charges | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 5 | Aetna 4488_aetna ppo 20250801 percent of total billed charges · outpatientfrom % of charges | $2.9k | $2.9k | — | — | — | $2.9k – $2.9k |
| 6 | Humana 206_humana hmo custom 20140201 percent of total billed charges · outpatientfrom % of charges | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 7 | Aetna 551_aetna hmo exchange (chi,dcn) 20170415 percent of total billed charges · outpatientfrom % of charges | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 8 | Aetna 552_aetna ppo exchange (chi,dcn) 20170415 percent of total billed charges · outpatientfrom % of charges | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 9 | 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 |
| 10 | UnitedHealthcare 3316_united healthcare standard nexus aco (chi,dcn) 20240101 percent of total billed charges · outpatientfrom % of charges | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 11 | Blue Cross Blue Shield 4455_blue cross blue shield hpn (chi,dcn) 20250501 percent of total billed charges · outpatientfrom % of charges | $3.3k | $3.3k | — | — | — | $3.3k – $3.3k |
| 12 | Aetna 3425_aetna sha aisd (ebd,shl) 20240701 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 13 | Aetna 4461_aetna aco hmo (ebd,shl) 20250701 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 14 | Aetna 1468_aetna hmo exchange (ebd,shl) 20170415 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 15 | Aetna 3435_aetna sha aisd (chi,dcn) 20240701 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 16 | 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 |
| 17 | Humana 124_humana hmo custom (chi,dcn) 20130201 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 18 | Humana 415_humana exchange (chi,dcn) 20160101 percent of total billed charges · outpatientfrom % of charges | $3.5k | $3.5k | — | — | — | $3.5k – $3.5k |
| 19 | Blue Cross Blue Shield 4092_blue cross blue shield hmo essentials (chi,dcn) 20250101 percent of total billed charges · outpatientfrom % of charges | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 20 | Oscar 3198_oscar health plan (chi,dcn) 20240101 percent of total billed charges · outpatientfrom % of charges | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 21 | Aetna 4483_aetna aco ppo/hmo (chi,dcn) 20250801 percent of total billed charges · outpatientfrom % of charges | $3.6k | $3.6k | — | — | — | $3.6k – $3.6k |
| 22 | Aetna 4462_aetna multi-tier whole health sha (ebd,shl) 20250701 percent of total billed charges · outpatientfrom % of charges | $3.8k | $3.8k | — | — | — | $3.8k – $3.8k |
| 23 | Aetna 4484_aetna multi-tier whole health sha (chi,dcn) 20250801 percent of total billed charges · outpatientfrom % of charges | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
| 24 | Blue Cross Blue Shield 4091_blue cross blue shield ppo (chi,dcn) 20250101 percent of total billed charges · outpatientfrom % of charges | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
| 25 | Cigna 4477_cigna hmo (chi,dcn) 20250101 percent of total billed charges · outpatientfrom % of charges | $4.0k | $4.0k | — | — | — | $4.0k – $4.0k |
Last updated: Jan 1, 2026
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