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
AQMBF PET REST & PHARM STRES
Teaneck, NJ
See all hospitals reporting RC 404 →Price type
Holy Name’s median price of $3.9k is 31% above the median hospital's median price ($3.0k), higher than 68% of the 1,496 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, 25 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 whole health facility · fee schedule · outpatient | $90 | $90 | — | — | — | $90 – $90 |
| 2 | Aetna medicare prime facility · percent of total billed charges · outpatientfrom % of charges | $0 | $307 | $434 | 141% | — | $0 – $920 |
| 3 | Aetna golden medicare facility · percent of total billed charges · outpatientfrom % of charges | $0 | $373 | $528 | 141% | — | $0 – $1.1k |
| 4 | Aetna medicare prime facility · fee schedule · outpatient | $1.5k | $1.5k | $330 | 22% | — | $330 – $2.4k |
| 5 | Aetna golden medicare facility · fee schedule · outpatient | $1.7k | $1.6k | $367 | 22% | — | $367 – $2.7k |
| 6 | Clover clover facility · fee schedule · outpatient | $1.7k | $1.6k | $367 | 22% | — | $367 – $2.7k |
| 7 | UnitedHealthcare medicare facility · fee schedule · outpatient | $1.7k | $1.6k | $367 | 22% | — | $367 – $2.7k |
| 8 | WellCare medicare facility · fee schedule · outpatient | $1.7k | $1.6k | $370 | 22% | — | $370 – $2.7k |
| 9 | UnitedHealthcare medicaid facility · percent of total billed charges · outpatientfrom % of charges | $2.3k | $1.7k | $967 | 55% | — | $0 – $2.7k |
| 10 | Aetna better health mcd/chip facility · percent of total billed charges · outpatientfrom % of charges | $2.4k | $1.8k | $1.0k | 55% | — | $0 – $2.9k |
| 11 | Aetna qualified health plans facility · percent of total billed charges · outpatientfrom % of charges | $2.8k | $2.1k | $1.2k | 55% | — | $0 – $3.3k |
| 12 | Cigna hmo/pos facility · percent of total billed charges · outpatientfrom % of charges | $3.1k | $2.5k | $1.9k | 75% | — | $0 – $4.4k |
| 13 | Ambetter ambetter facility · percent of total billed charges · outpatientfrom % of charges | $3.6k | $2.7k | $1.5k | 55% | — | $0 – $4.3k |
| 14 | Aetna whole health facility · percent of total billed charges · outpatientfrom % of charges | $4.6k | $3.5k | $1.9k | 55% | — | $0 – $5.5k |
| 15 | Aetna hmo/pos facility · percent of total billed charges · outpatientfrom % of charges | $4.9k | $3.7k | $2.0k | 55% | — | $0 – $5.8k |
| 16 | Cigna hmo/pos facility · fee schedule · outpatient | $5.2k | $4.6k | $1.3k | 28% | — | $0 – $5.2k |
| 17 | First Health first health facility · percent of total billed charges · outpatientfrom % of charges | $6.9k | $5.2k | $2.9k | 55% | — | $0 – $8.2k |
| 18 | Aetna worker's comp facility · percent of total billed charges · outpatientfrom % of charges | $8.8k | $6.7k | $3.7k | 55% | — | $0 – $10.5k |
| 19 | MultiPlan multiplan facility · percent of total billed charges · outpatientfrom % of charges | $9.4k | $7.1k | $3.9k | 55% | — | $0 – $11.2k |
| 20 | MultiPlan worker's comp facility · percent of total billed charges · outpatientfrom % of charges | $12.3k | $9.3k | $5.1k | 55% | — | $0 – $14.6k |
| 21 | MultiPlan auto accident medical facility · percent of total billed charges · outpatientfrom % of charges | $13.0k | $9.8k | $5.5k | 55% | — | $0 – $15.5k |
| 22 | Blue Cross Blue Shield indemnity facility · percent of total billed charges · outpatientfrom % of charges | $13.4k | $10.1k | $5.6k | 55% | — | $0 – $15.9k |
| 23 | Blue Cross Blue Shield managed facility · percent of total billed charges · outpatientfrom % of charges | $13.4k | $10.1k | $5.6k | 55% | — | $0 – $15.9k |
| 24 | Blue Cross Blue Shield ppo facility · percent of total billed charges · outpatientfrom % of charges | $13.4k | $10.1k | $5.6k | 55% | — | $0 – $15.9k |
| 25 | UnitedHealthcare uhc facility · other · outpatient | $10.3k | $10.3k | — | — | — | $10.3k – $10.3k |
Last updated: Nov 10, 2025
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