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
HC PET W CT ATTENUATION, WHOLE BODY
Edina, MN
See all hospitals reporting RC 404 →Price type
Fairview Health Services’s median price of $2.6k is 15% below the median hospital's median price ($3.0k), higher than 42% of the 1,512 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: 9 payers, 39 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 | Sanford Health Plan medicare advantage fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 2 | UnitedHealthcare medicare advantage fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 3 | WellCare medicare advantage fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 4 | Ucare medicare advantage/msho fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 5 | Medica medicare advantage non-snp other · inpatient | $1.5k | $1.5k | — | — | 4–40 | $1.5k – $1.5k |
| 6 | Optum behavioral commercial other · inpatient | $1.5k | $1.5k | — | — | 4–40 | $1.5k – $1.5k |
| 7 | Optum behavioral commercial other · outpatient | $1.5k | $1.5k | — | — | 4–40 | $1.5k – $1.5k |
| 8 | UnitedHealthcare medicare advantage other · inpatient | $1.5k | $1.5k | — | — | 16–52 | $1.5k – $1.5k |
| 9 | Ucare medicare advantage/msho other · inpatient | $1.5k | $1.5k | $19 | 1% | 64 | $1.5k – $1.5k |
| 10 | Ucare pmap other · inpatient | $1.5k | $1.5k | — | — | 7–70 | $1.5k – $1.5k |
| 11 | Ucare pmap fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 12 | Bcbs Mn medicare advantage fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 13 | Bcbs Mn medicare advantage other · inpatient | $1.5k | $1.5k | — | — | 50 | $1.5k – $1.5k |
| 14 | Medica medicare advantage non-snp fee schedule · outpatient | $1.5k | $1.5k | — | — | — | $1.5k – $1.5k |
| 15 | Medica managed medicaid/accessability fee schedule · outpatient | $1.7k | $1.6k | $220 | 14% | — | $1.1k – $1.8k |
| 16 | Medica managed medicaid/accessability other · inpatient | $1.6k | $1.6k | $23 | 1% | 23–50 | $1.6k – $1.6k |
| 17 | Medica msho/medicare advantage snp fee schedule · outpatient | $1.9k | $1.7k | $238 | 14% | — | $1.1k – $1.9k |
| 18 | Bcbs Mn pmap fee schedule · outpatient | $1.8k | $1.8k | — | — | — | $1.8k – $1.8k |
| 19 | UnitedHealthcare commercial other · inpatient | $2.1k | $2.1k | $60 | 3% | 7–70 | $2.1k – $2.2k |
| 20 | UnitedHealthcare commercial fee schedule · outpatient | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 21 | UnitedHealthcare core fee schedule · outpatient | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 22 | Ucare individual and family with m health fairview fee schedule · outpatient | $2.6k | $2.6k | — | — | — | $2.6k – $2.6k |
| 23 | Medica bold fee schedule · outpatient | $3.2k | $2.9k | $408 | 14% | — | $2.0k – $3.3k |
| 24 | Medica city of st. paul/essential-uplan fee schedule · outpatient | $3.3k | $3.0k | $423 | 14% | — | $2.0k – $3.4k |
| 25 | Sanford Health Plan commercial percent of total billed charges · inpatientfrom % of charges | $2.9k | $3.0k | $393 | 13% | — | $2.6k – $3.7k |
Last updated: Feb 6, 2026
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