RC 402

Ultrasound imaging service at Santa Rosa Hospital - Westover Hills

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

HC 76642 US BREAST,UNILAT, LMTD

San Antonio, TX

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Pricing by billing methodology

Price type

How this price compares nationally

Santa Rosa Hospital - Westover Hills’s median price of $140 is 53% below the median hospital's median price ($300), higher than 13% of the 1,982 hospitals reporting RC 402. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting RC 402 at Santa Rosa Hospital - Westover Hills

Negotiated rates from the hospital’s own file: 12 payers, 51 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	Aetna mm fee schedule · outpatient	$99.85	$86.58	$11.55 – $292.40
2	UnitedHealthcare chip km fee schedule · outpatient	$92.55	$94.66	$30.35 – $248.83
3	UnitedHealthcare star km fee schedule · outpatient	$92.55	$94.66	$30.35 – $248.83
4	UnitedHealthcare star plus km fee schedule · outpatient	$92.55	$94.66	$30.35 – $248.83
5	Bcbs Tx mm fee schedule · outpatient	$99.85	$109.78	$82.68 – $292.40
6	Humana gold choice mm fee schedule · outpatient	$99.85	$109.78	$82.68 – $292.40
7	Humana gold plus mm fee schedule · outpatient	$99.85	$109.78	$82.68 – $292.40
8	Molina medicare adv mm fee schedule · outpatient	$99.85	$109.78	$82.68 – $292.40
9	UnitedHealthcare mm fee schedule · outpatient	$99.85	$109.78	$82.68 – $292.40
10	WellCare mm fee schedule · outpatient	$99.85	$109.78	$82.68 – $292.40
11	Devoted mm fee schedule · outpatient	$107.84	$118.56	$89.29 – $315.79
12	Aetna new business fee schedule · outpatient	$133.79	$130.80	$31.19 – $378.11
13	Aetna chip km fee schedule · outpatient	$134.67	$143.17	$66.04 – $352.88
14	Aetna star km fee schedule · outpatient	$134.67	$143.17	$66.04 – $352.88
15	Bcbs Tx star chip km fee schedule · outpatient	$134.67	$143.17	$66.04 – $352.88
16	Molina chip km fee schedule · outpatient	$134.67	$143.17	$66.04 – $352.88
17	Molina star plus km fee schedule · outpatient	$134.67	$143.17	$66.04 – $352.88
18	Aetna epo fee schedule · outpatient	$148.65	$145.34	$34.65 – $420.12
19	Aetna hmo fee schedule · outpatient	$148.65	$145.34	$34.65 – $420.12
20	Aetna pos fee schedule · outpatient	$148.65	$145.34	$34.65 – $420.12
21	Aetna ppo fee schedule · outpatient	$148.65	$145.34	$34.65 – $420.12
22	Humana choicecare fee schedule · outpatient	$174.49	$189.57	$58.27 – $779.00
23	Cigna new business fee schedule · outpatient	$211.88	$213.93	$33.36 – $1,028
24	Bcbs Tx blue advantangehmo fee schedule · outpatient	$272.85	$255.89	$41.19 – $720.09
25	Cigna ppo fee schedule · outpatient	$268.31	$270.96	$42.24 – $1,306

Page 1 of 3 · 51 rates

Last updated: Jan 13, 2026

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