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 % IN WATER (D5W) INTRAVENOUS SOLP [25496]
Arlington, TX
See all hospitals reporting RC 258 →Price type
AMH Cath Labs LLC’s median price of $35 is 7% below the median hospital's median price ($38), higher than 47% of the 1,497 hospitals reporting RC 258. 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, 29 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 managed medicaid percent of total billed charges · outpatientfrom % of charges | $4.45 | $9.94 | $4.45 – $63.01 |
| 2 | UnitedHealthcare managed medicaid percent of total billed charges · outpatientfrom % of charges | $4.45 | $9.94 | $4.45 – $63.01 |
| 3 | WellCare managed medicaid percent of total billed charges · outpatientfrom % of charges | $4.68 | $10.44 | $4.68 – $66.20 |
| 4 | Molina managed medicaid percent of total billed charges · outpatientfrom % of charges | $4.81 | $10.73 | $4.81 – $68.04 |
| 5 | Aetna managed medicaid percent of total billed charges · outpatientfrom % of charges | $4.90 | $10.93 | $4.90 – $69.31 |
| 6 | Blue Cross Blue Shield hmo fee schedule · outpatient | $12.17 | $11.39 | $3.44 – $30.52 |
| 7 | Blue Cross Blue Shield exchange fee schedule · outpatient | $12.47 | $11.68 | $3.53 – $31.29 |
| 8 | Blue Cross Blue Shield ppo fee schedule · outpatient | $13.52 | $12.66 | $3.82 – $33.91 |
| 9 | Aetna whole health percent of total billed charges · inpatientfrom % of charges | $17.29 | $38.61 | $17.29 – $244.83 |
| 10 | Blue Cross Blue Shield exchange percent of total billed charges · outpatientfrom % of charges | $20.81 | $41.53 | $14.50 – $205.32 |
| 11 | Aetna whole health percent of total billed charges · outpatientfrom % of charges | $20.53 | $45.85 | $20.53 – $290.70 |
| 12 | Aetna commercial percent of total billed charges · inpatientfrom % of charges | $23.05 | $51.48 | $23.05 – $326.39 |
| 13 | Blue Cross Blue Shield traditional fee schedule · outpatient | $55.31 | $51.80 | $15.64 – $138.75 |
| 14 | UnitedHealthcare all payer percent of total billed charges · outpatientfrom % of charges | $25.86 | $57.75 | $25.86 – $366.18 |
| 15 | Aetna commercial percent of total billed charges · outpatientfrom % of charges | $27.38 | $61.14 | $27.38 – $387.63 |
| 16 | UnitedHealthcare ppo percent of total billed charges · outpatientfrom % of charges | $27.40 | $61.19 | $27.40 – $387.98 |
| 17 | Cigna oap/hmo percent of total billed charges · outpatientfrom % of charges | $27.64 | $61.73 | $27.64 – $391.38 |
| 18 | Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges | $33.15 | $66.16 | $23.10 – $327.10 |
| 19 | Blue Cross Blue Shield ppo percent of total billed charges · outpatientfrom % of charges | $36.88 | $73.61 | $25.70 – $363.91 |
| 20 | Phcs ppo percent of total billed charges · outpatientfrom % of charges | $34.75 | $77.61 | $34.75 – $492.06 |
| 21 | Cigna ppo percent of total billed charges · outpatientfrom % of charges | $34.85 | $77.83 | $34.85 – $493.48 |
| 22 | Aetna asa percent of total billed charges · outpatientfrom % of charges | $35.05 | $78.27 | $35.05 – $496.31 |
| 23 | Aetna coventry percent of total billed charges · outpatientfrom % of charges | $35.05 | $78.27 | $35.05 – $496.31 |
| 24 | Phcs ppo percent of total billed charges · inpatientfrom % of charges | $37.25 | $83.19 | $37.25 – $527.46 |
| 25 | MultiPlan commercial percent of total billed charges · inpatientfrom % of charges | $43.50 | $97.15 | $43.50 – $615.96 |
Last updated: Apr 21, 2026
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