RC 804
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
CCPD TREATMENT
Jamestown, NY
See all hospitals reporting RC 804 →Price type
UPMC Chautauqua’s median price of $536 is 28% below the median hospital's median price ($742), higher than 33% of the 482 hospitals reporting RC 804. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 8 payers, 20 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 | Blue Cross Blue Shield essential plans 3&4 facility · fee schedule · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 2 | Molina chip (for kids)/medicaid facility · case rate · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 3 | UnitedHealthcare medicaid facility · case rate · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 4 | Blue Cross Blue Shield essential plans 1&2 facility · fee schedule · outpatient | $116 | $116 | — | — | — | $116 – $116 |
| 5 | Blue Cross Blue Shield medicaid facility · fee schedule · outpatient | $160 | $160 | — | — | — | $160 – $160 |
| 6 | Molina essential plan facility · case rate · outpatient | $217 | $217 | — | — | — | $217 – $217 |
| 7 | Humana medicare facility · fee schedule · outpatient | $520 | $520 | — | — | — | $520 – $520 |
| 8 | UnitedHealthcare medicare facility · fee schedule · outpatient | $520 | $520 | — | — | — | $520 – $520 |
| 9 | WellCare medicare facility · fee schedule · outpatient | $536 | $536 | — | — | — | $536 – $536 |
| 10 | Aetna medicare facility · fee schedule · outpatient | $541 | $541 | — | — | — | $541 – $541 |
| 11 | Blue Cross Blue Shield commercial facility · fee schedule · outpatient | $1.3k | $1.3k | — | — | — | $1.3k – $1.3k |
| 12 | UnitedHealthcare commercial facility · percent of total billed charges · outpatientfrom % of charges | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 13 | Aetna commercial facility · percent of total billed charges · inpatientfrom % of charges | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 14 | Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 15 | UnitedHealthcare commercial facility · percent of total billed charges · inpatientfrom % of charges | $2.4k | $2.4k | — | — | — | $2.4k – $2.4k |
| 16 | Humana commercial facility · percent of total billed charges · inpatientfrom % of charges | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 17 | MultiPlan ppo (includes phcs as a payer) facility · percent of total billed charges · inpatientfrom % of charges | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 18 | MultiPlan ppo (includes phcs as a payer) facility · percent of total billed charges · outpatientfrom % of charges | $2.8k | $2.8k | — | — | — | $2.8k – $2.8k |
| 19 | Humana commercial facility · percent of total billed charges · outpatientfrom % of charges | $3.0k | $3.0k | — | — | — | $3.0k – $3.0k |
| 20 | First Health ppo facility · percent of total billed charges · outpatientfrom % of charges | $3.4k | $3.4k | — | — | — | $3.4k – $3.4k |
Last updated: Mar 6, 2026
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