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
Pet CT Lmt Area
Summit, NJ
See all hospitals reporting RC 404 →Price type
Overlook Medical Center’s median price of $2.1k is 30% below the median hospital's median price ($3.0k), higher than 30% 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: 18 payers, 64 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 omc cigna oap fee schedule · outpatient | $77 | $77 | — | — | — | $77 – $77 |
| 2 | Blue Cross Blue Shield omc horizon omnia fee schedule · both | $1.2k | $1.1k | $299 | 28% | — | $259 – $1.2k |
| 3 | Blue Cross Blue Shield omc horizon commercial fee schedule · both | $1.3k | $1.1k | $325 | 28% | — | $282 – $1.3k |
| 4 | Blue Cross Blue Shield omc horizon omnia fee schedule · outpatient | $1.2k | $1.2k | — | — | — | $1.2k – $1.2k |
| 5 | Blue Cross Blue Shield omc horizon commercial fee schedule · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 6 | Anthem omc medicaid percent of total billed charges · bothfrom % of charges | $1.9k | $1.5k | $524 | 35% | — | $784 – $1.9k |
| 7 | Medicaid omc medicaid percent of total billed charges · bothfrom % of charges | $1.9k | $1.5k | $524 | 35% | — | $784 – $1.9k |
| 8 | Cigna omc cigna local plus per diem · both | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 9 | Cigna omc cigna local plus per diem · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 10 | Aetna omc aetna whole health fee schedule · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 11 | Aetna omc aetna whole health fee schedule · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 12 | Aetna omc aetna ahs employee other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 13 | Aetna omc aetna medicare fee schedule · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 14 | Aetna omc aetna nnj prime other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 15 | Ambetter omc ambetter wellcare of nj other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 16 | Anthem omc horizon braven other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 17 | Blue Cross Blue Shield omc horizon braven other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 18 | Cigna omc cigna medicare fee schedule · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 19 | Highmark omc highmark wholecare / gateway health plan inc other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 20 | Highmark omc horizon braven other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 21 | Tricare omc tricare contract other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 22 | Tricare omc tricare-east (humana military) other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 23 | WellCare omc wellcare phw other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 24 | WellCare omc wellcare/fedelis medicare other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 25 | Amerihealth Caritas omc amerihealth caritas other · both | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
Last updated: Apr 1, 2026
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