RC 390
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 P9011 FFP PEDI SPLIT UNIT
San Antonio, TX
See all hospitals reporting RC 390 →Price type
Santa Rosa Hospital - Westover Hills’s median price of $185 is 53% below the median hospital's median price ($397), higher than 10% of the 1,885 hospitals reporting RC 390. 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, 57 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 | Cigna new business fee schedule · outpatient | $66.83 | $73.38 | $36.38 – $116.93 |
| 2 | Aetna chip km percent of total billed charges · outpatientfrom % of charges | $47.63 | $80.72 | $13.42 – $181.61 |
| 3 | Aetna star km percent of total billed charges · outpatientfrom % of charges | $47.63 | $80.72 | $13.42 – $181.61 |
| 4 | Bcbs Tx star chip km percent of total billed charges · outpatientfrom % of charges | $47.63 | $80.72 | $13.42 – $181.61 |
| 5 | Cigna ppo fee schedule · outpatient | $84.63 | $92.93 | $46.08 – $148.08 |
| 6 | UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges | $94.41 | $129.44 | $21.96 – $297.18 |
| 7 | UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges | $94.41 | $129.44 | $21.96 – $297.18 |
| 8 | UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges | $94.41 | $129.44 | $21.96 – $297.18 |
| 9 | Aetna epo fee schedule · outpatient | $77.88 | $134.93 | $44.49 – $282.42 |
| 10 | Aetna pos fee schedule · outpatient | $77.88 | $134.93 | $44.49 – $282.42 |
| 11 | Aetna ppo fee schedule · outpatient | $77.88 | $134.93 | $44.49 – $282.42 |
| 12 | Bcbs Tx mm fee schedule · outpatient | $142.63 | $193.97 | $23.00 – $634.43 |
| 13 | Humana gold choice mm fee schedule · outpatient | $142.63 | $193.97 | $23.00 – $634.43 |
| 14 | Humana gold plus mm fee schedule · outpatient | $142.63 | $193.97 | $23.00 – $634.43 |
| 15 | Molina medicare adv mm fee schedule · outpatient | $142.63 | $193.97 | $23.00 – $634.43 |
| 16 | UnitedHealthcare mm fee schedule · outpatient | $142.63 | $193.97 | $23.00 – $634.43 |
| 17 | WellCare mm fee schedule · outpatient | $142.63 | $193.97 | $23.00 – $634.43 |
| 18 | Devoted mm fee schedule · outpatient | $154.04 | $209.49 | $24.84 – $685.18 |
| 19 | Molina chip km percent of total billed charges · outpatientfrom % of charges | $129.90 | $220.16 | $36.60 – $495.30 |
| 20 | Molina star plus km percent of total billed charges · outpatientfrom % of charges | $129.90 | $220.16 | $36.60 – $495.30 |
| 21 | Aetna mm fee schedule · outpatient | $151.77 | $226.48 | $23.00 – $779.12 |
| 22 | Aetna new business fee schedule · outpatient | $254.18 | $254.18 | $254.18 – $254.18 |
| 23 | Aetna chip km fee schedule · outpatient | $124.83 | $258.58 | $51.00 – $1,094 |
| 24 | Aetna star km fee schedule · outpatient | $124.83 | $258.58 | $51.00 – $1,094 |
| 25 | Bcbs Tx star chip km fee schedule · outpatient | $124.83 | $258.58 | $51.00 – $1,094 |
Last updated: Jan 13, 2026
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