RC 258
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
DEXTROSE 5 % IV SOLN
The hospitals that file a Clover 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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15 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Central Georgia Rehabilitation LLC Macon, GA fee schedule · outpatient | 1 | $16.62 | $16.62 – $16.62 |
| 2 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · both | 2 | $3.95 | $3.95 – $3.95 |
| 3 | East Cooper Medical Center LLC Mt Pleasant, SC percent of total billed charges · bothfrom % of charges | 2 | $130.70 | $1.20 – $534.90 |
| 4 | Hackensack Meridian at Pascack Valley Westwood, NJ facility · percent of total billed charges · bothfrom % of charges | 1 | $2.98 | $1.15 – $4.01 |
| 5 | Higgins General Hospital Bremen, GA facility · per diem · inpatient | 1 | $2,941 | $2,941 – $2,941 |
| 6 | Hilton Head Medical Center LLC Hilton Head Island, SC fee schedule · both | 2 | $3.95 | $3.95 – $3.95 |
| 7 | Hilton Head Medical Center LLC Hilton Head Island, SC percent of total billed charges · bothfrom % of charges | 2 | $119.26 | $6.90 – $778.20 |
| 8 | Polk Medical Center Inc Cedartown, GA percent of total billed charges · outpatientfrom % of charges | 1 | $26.70 | $0.13 – $223.86 |
| 9 | Presbyterian Medical Center of the University of Pennsylvania Health System D/B/A Penn Presbyterian Medical Center Philadelphia, PA facility · other · outpatient | 1 | $22.00 | $22.00 – $22.00 |
| 10 | South Carolina Coastal Medical Center LLC Hardeeville, SC fee schedule · both | 2 | $3.95 | $3.95 – $3.95 |
| 11 | South Carolina Coastal Medical Center LLC Hardeeville, SC percent of total billed charges · bothfrom % of charges | 2 | $146.42 | $6.30 – $858.30 |
| 12 | Tanner Medical Center - East Alabama Wedowee, AL facility · per diem · inpatient | 1 | $2,949 | $2,949 – $2,949 |
| 13 | The Medical Center of Central Georgia Inc Macon, GA fee schedule · outpatient | 1 | $16.62 | $16.62 – $16.62 |
| 14 | The Medical Center of Peach County Inc Byron, GA percent of total billed charges · outpatientfrom % of charges | 1 | $39.62 | $0.11 – $678.39 |
| 15 | The Trustees of the University of Pennsylvania D/B/A The Hospital of the University of Pennsylvania Philadelphia, PA facility · other · outpatient | 1 | $333.75 | $15.00 – $1,605 |
← Payers reporting RC 258 · Snapshot 20261108T203506Z-bb90dbab