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
NM Pet W CT Imaging Whole Body
Smith, AR
See all hospitals reporting RC 404 →Price type
Mercy Hospital Fort Smith’s median price of $1.5k is 51% below the median hospital's median price ($3.0k), higher than 14% 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: 17 payers, 32 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 hb ftsm managed medicare facility · fee schedule · outpatient | $4 | $15 | $14 | 92% | — | $4 – $33 |
| 2 | Aetna hb ftsm coventry/aetna facility · fee schedule · outpatient | $140 | $148 | $34 | 23% | — | $112 – $188 |
| 3 | First Health hb ftsm first health_ccn facility · fee schedule · outpatient | $197 | $208 | $48 | 23% | — | $157 – $265 |
| 4 | Medicaid hb ftsm ark medicaid facility · fee schedule · outpatient | $226 | $739 | $688 | 93% | — | $43 – $1.5k |
| 5 | Caresource hb ftsm caresource medicaid facility · fee schedule · outpatient | $231 | $754 | $702 | 93% | — | $44 – $1.5k |
| 6 | Medicaid hb ftsm ok medicaid facility · fee schedule · outpatient | $1.2k | $1.2k | $426 | 36% | — | $126 – $1.9k |
| 7 | Aetna hb ftsm ok managed medicaid facility · fee schedule · outpatient | $1.3k | $1.3k | $441 | 35% | — | $152 – $1.9k |
| 8 | Humana hb ftsm ok managed medicaid facility · fee schedule · outpatient | $1.3k | $1.3k | $441 | 35% | — | $152 – $1.9k |
| 9 | Medicaid hb ftsm mo medicaid facility · fee schedule · outpatient | $1.2k | $1.4k | $316 | 22% | — | $1.1k – $2.0k |
| 10 | Blue Cross Blue Shield hb ftsm bcbs exchange facility · fee schedule · outpatient | $1.4k | $1.5k | $684 | 47% | — | $32 – $2.8k |
| 11 | Aetna hb ftsm managed medicare facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | — | $1.2k – $2.1k |
| 12 | Blue Cross Blue Shield hb ftsm managed medicare facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | — | $1.2k – $2.1k |
| 13 | First Health hb ftsm managed medicare facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | — | $1.2k – $2.1k |
| 14 | Humana hb ftsm humana mcr facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | 2–20 | $1.2k – $2.1k |
| 15 | Medica hb ftsm managed medicare facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | — | $1.2k – $2.1k |
| 16 | Medicare hb ftsm medicare facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | 2–20 | $1.2k – $2.1k |
| 17 | UnitedHealthcare hb ftsm managed medicare facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | 2–20 | $1.2k – $2.1k |
| 18 | UnitedHealthcare hb ftsm uhc mcr 100% facility · other · outpatient | $1.4k | $1.5k | $314 | 21% | 262–298 | $1.2k – $2.1k |
| 19 | Tricare hb ftsm tricare facility · other · outpatient | $1.4k | $1.5k | $336 | 22% | 4–40 | $1.2k – $2.1k |
| 20 | WellCare hb ftsm novasys mcr 103% facility · other · outpatient | $1.4k | $1.6k | $323 | 21% | — | $1.3k – $2.2k |
| 21 | Devoted hb ftsm devoted health mcr facility · other · outpatient | $1.4k | $1.6k | $327 | 21% | — | $1.3k – $2.2k |
| 22 | Cigna hb ftsm healthspring cigna mcr 105% facility · other · outpatient | $1.4k | $1.6k | $330 | 21% | — | $1.3k – $2.2k |
| 23 | Anthem hb ftsm blue cross facility · fee schedule · outpatient | $1.6k | $1.6k | $766 | 47% | — | $36 – $3.1k |
| 24 | Blue Cross Blue Shield hb ftsm blue cross facility · fee schedule · outpatient | $1.6k | $1.6k | $766 | 47% | — | $36 – $3.1k |
| 25 | Ambetter hb ftsm novasys ambetter exchange facility · other · outpatient | $1.9k | $2.2k | $480 | 22% | 16–52 | $1.8k – $3.0k |
Last updated: Jun 8, 2026
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