RC 258

Pharmacy charge

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

DEXTROSE 5 % IV SOLN

Aetna rates for RC 258

The hospitals that file a Aetna rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.

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1,688 hospital rates

#		Plans
1	ACADIA GENERAL HOSPITAL, INC 1305 CROWLEY RAYNE HWY other · outpatient	1	$33.60	$33.60 – $33.60
2	ADVENTIST HEALTH CLEARLAKE HOSPITAL INC Clearlake, CA percent of total billed charges · outpatientfrom % of charges	1	$120.84	$120.84 – $120.84
3	ADVENTIST HEALTH DELANO Delano, CA percent of total billed charges · outpatientfrom % of charges	1	$63.56	$63.56 – $63.56
4	ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient	1	$369.50	$369.50 – $369.50
5	ADVENTIST HEALTH TULARE Tulare, CA percent of total billed charges · outpatientfrom % of charges	1	$85.60	$85.60 – $85.60
6	AHS Claremore Hospital, LLC Claremore, OK facility · percent of total billed charges · bothfrom % of charges	1	$46.51	$38.15 – $48.36
7	AHS Cushing Hospital, LLC Cushing, OK facility · percent of total billed charges · bothfrom % of charges	1	$40.02	$40.02 – $40.02
8	AHS Henryetta Hospital, LLC Henryetta, OK facility · percent of total billed charges · bothfrom % of charges	1	$34.75	$34.75 – $34.75
9	AHS Hillcrest Medical Center, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges	2	$49.04	$38.15 – $58.10
10	AHS Pryor Hospital, LLC Pryor, OK facility · percent of total billed charges · bothfrom % of charges	2	$46.51	$38.15 – $48.36
11	AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges	2	$46.87	$38.15 – $48.25
12	AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient	2	$2.51	$2.33 – $2.69
13	AKRON GENERAL MEDICAL CENTER Akron, OH facility · other · outpatient	1	$2.17	$2.17 – $2.17
14	AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · bothfrom % of charges	2	$0.37	$0.02 – $8.16
15	AKRON GENERAL MEDICAL CENTER Akron, OH facility · percent of total billed charges · outpatientfrom % of charges	4	$0.24	$0.01 – $5.71
16	ALBANY GENERAL HOSPITAL Albany, OR facility · percent of total billed charges · bothfrom % of charges	1	$82.31	$0.11 – $909.72
17	AMH Cath Labs LLC Arlington, TX percent of total billed charges · inpatientfrom % of charges	2	$45.04	$17.29 – $326.39
18	AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges	5	$54.89	$4.90 – $496.31
19	ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · bothfrom % of charges	1	$31.19	$7.04 – $62.48
20	ARH Mary Breckinridge Health Services, Inc Barbourville, KY percent of total billed charges · outpatientfrom % of charges	1	$8.51	$1.92 – $17.04
21	ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · bothfrom % of charges	1	$32.51	$7.92 – $61.60
22	ARH Mary Breckinridge Health Services, Inc Hayden, KY percent of total billed charges · outpatientfrom % of charges	1	$7.76	$1.89 – $14.70
23	ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · bothfrom % of charges	1	$30.57	$7.04 – $50.16
24	ARH Mary Breckinridge Health Services, Inc Martin, KY percent of total billed charges · outpatientfrom % of charges	1	$9.03	$2.08 – $14.82
25	ARH Tug Valley Health Services, Inc. Paintsville, KY percent of total billed charges · bothfrom % of charges	1	$35.89	$6.00 – $312.00

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