RC 255
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.
Generation details were not recorded for this description.
Original text from hospital filings
GADOXETATE DISODIUM 0.25 MMOL/ML IV SOLN
Maple Grove, MN
See all hospitals reporting RC 255 →Price type
Fairview Maple Grove Surgery Center’s median price of $1 is 99% below the median hospital's median price ($54), higher than 5% of the 1,205 hospitals reporting RC 255. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 4 payers, 7 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 federal fee schedule · outpatient | $0.33 | $6.45 | $0.08 – $45.78 |
| 2 | Blue Cross Blue Shield commercial fee schedule · outpatient | $0.34 | $6.57 | $0.08 – $46.60 |
| 3 | Blue Cross Blue Shield medicaid fee schedule · outpatient | $0.34 | $6.57 | $0.08 – $46.60 |
| 4 | Ucare ifp percent of total billed charges · outpatientfrom % of charges | $1.35 | $17.75 | $0.09 – $132.50 |
| 5 | Ucare ifp with fairview percent of total billed charges · outpatientfrom % of charges | $1.35 | $17.75 | $0.09 – $132.50 |
| 6 | First Health commercial percent of total billed charges · outpatientfrom % of charges | $1.77 | $28.36 | $0.15 – $217.30 |
| 7 | MultiPlan commercial percent of total billed charges · outpatientfrom % of charges | $1.83 | $29.42 | $0.15 – $225.25 |
Last updated: May 18, 2026
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