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Revenue Code (RC) 0404 Fee Schedule

Last Verified: January 2026

Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.

Positron Emission Tomography

Key FactDetail
Service Type

Other Imaging Services

Complexity LevelModerate

National average reimbursement for Revenue Code 0404 by major payers:

bcbs

$721.06

uhc

$3,344.43

aetna

$4,552.40

cigna

$3,638.52

Preview provider-level rates for...
For billing codeRC 0404
PayerCodeRateNPITax IDStateSpecialty

Select a payer to view fee schedule data

Choose a payer from the options above to see rates for RC 0404

United
0404$1639.001023074028 - GEORGE COUNTY HOSPITAL646001398MSRural Acute Care Hospital (282NR1301X)
United
0404$3186.001518957950 - BOLIVAR GENERAL HOSPITAL, INC., WEST TENNESSEE HEALTHCARE BOLIVAR HOSPITAL621624171 - (TN) BOLIVAR GENERAL HOSPITAL INCTNCritical Access Hospital (282NC0060X)
United
0404$3360.001114931342 - INTEGRIS MIAMI HOSPITAL, INTEGRIS MIAMI HOSPITAL730584411OKGeneral Acute Care Hospital (282N00000X)
United
0404$5118.001629057229 - AHS HILLCREST MEDICAL CENTER, LLC, HILLCREST MEDICAL CENTER770633896 - (OK) AHS HILLCREST MEDICAL CENTER LLCOKGeneral Acute Care Hospital (282N00000X)
United
0404$5017.001801320718 - STEWARD MELBOURNE HOSPITAL, INC.815354550FLGeneral Acute Care Hospital (282N00000X)
United
0404$5549.001801826912 - WELLMONT HEALTH SYSTEM, LONESOME PINE HOSPITAL621636465 - WELLMONT HEALTH SYSTEMVAGeneral Acute Care Hospital (282N00000X)
United
0404$2839.001649226952 - ANDERSON REGIONAL MEDICAL CENTER, ANDERSON REGIONAL MEDICAL CENTER640362400 - (MS) ANDERSON REGIONAL MEDICAL CENTERMSGeneral Acute Care Hospital (282N00000X)
United
0404$5494.001467595793 - TRUMAN MEDICAL CENTER, INCORPORATED, UNIVERSITY HEALTH TRUMAN MEDICAL CENTER440661018 - (MO) TRUMAN MEDICAL CENTER INCORPORATEDMOGeneral Acute Care Hospital (282N00000X)
United
0404$2903.001518957950 - BOLIVAR GENERAL HOSPITAL, INC., WEST TENNESSEE HEALTHCARE BOLIVAR HOSPITAL621624171 - (TN) BOLIVAR GENERAL HOSPITAL INCTNCritical Access Hospital (282NC0060X)
United
0404$2235.001124073879 - ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS, INC, ATMORE COMMUNITY HOSPITAL631143638 - ESCAMBIA COUNTY ALABAMA COMMUNITY HOSPITALS INCALRural Acute Care Hospital (282NR1301X)
United
0404$4323.001225195340 - INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL, INC.350867958 - (IN) INDIANA UNIVERSITY HEALTH BALL MEMORIAL HOSPITAL INCINGeneral Acute Care Hospital (282N00000X)
United
0404$1902.001417944224 - IREDELL MEMORIAL HOSPITAL, INCORPORATED560591303 - (NC) IREDELL MEMORIAL HOSPITAL INCORPORATEDNCGeneral Acute Care Hospital (282N00000X)
United
0404$3121.001447230388 - OPELOUSAS GENERAL HOSPITAL AUTHORITY720708111LAGeneral Acute Care Hospital (282N00000X)
United
0404$2122.001083659734 - NESHOBA COUNTY GENERAL HOSPITAL646000892MSGeneral Acute Care Hospital (282N00000X)
United
0404$5793.001124058615 - WELLMONT HEALTH SYSTEM, BRISTOL REGIONAL MEDICAL CENTER621636465 - WELLMONT HEALTH SYSTEMTNGeneral Acute Care Hospital (282N00000X)
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist
United
99202$100.0012345678901234567890CACardiologist

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Revenue Code 0404 vs. Other Other Imaging Services Codes

The Revenue Code 0404 code is part of the Other Imaging Services services . It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.

The Revenue Code 0404 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.

CodeComplexityDescription
0403-RCModerateScreening mammography
0404-RCModeratePositron Emission Tomography
0405-RCLowOther Imaging Services

What is a fee schedule?

A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including Revenue Code 0404. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.

Understanding the 0404 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.

Factors that affect fee schedules


Medicare & Medicaid Rates

Government-set reimbursement amounts


Private Insurance Rates

Negotiated rates between providers and insurance companies


Geographic Location

Costs may be higher in urban areas.


Provider Type

Hospital providers may have different rates than private practice.

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