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
INJECTION, SULFUR HEXAFLUORIDE LIPID MICROSPHERES, PER ML
Lodi, CA
See all hospitals reporting RC 255 →Price type
Lodi Memorial Hospital Association Inc’s median price of $61 is 13% above the median hospital's median price ($54), higher than 52% 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: 8 payers, 14 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 blue cross exchange fee schedule · outpatient | $16.21 | $16.21 | $16.21 – $16.21 |
| 2 | Blue Cross Blue Shield blue cross non-mcs - all other plans fee schedule · outpatient | $18.02 | $18.02 | $18.02 – $18.02 |
| 3 | Blue Cross Blue Shield blue shield epn - all other plans percent of total billed charges · outpatientfrom % of charges | $40.50 | $40.50 | $40.50 – $40.50 |
| 4 | Aetna aetna - all plans fee schedule · outpatient | $40.88 | $40.88 | $40.88 – $40.88 |
| 5 | Blue Cross Blue Shield blue shield non-epn percent of total billed charges · outpatientfrom % of charges | $42.00 | $42.00 | $42.00 – $42.00 |
| 6 | UnitedHealthcare uhc jll percent of total billed charges · outpatientfrom % of charges | $49.29 | $49.29 | $49.29 – $49.29 |
| 7 | Kaiser kaiser commercial - all other plans percent of total billed charges · outpatientfrom % of charges | $51.25 | $51.25 | $51.25 – $51.25 |
| 8 | UnitedHealthcare uhc all payer - all other plans percent of total billed charges · outpatientfrom % of charges | $51.89 | $51.89 | $51.89 – $51.89 |
| 9 | UnitedHealthcare uhc hmo percent of total billed charges · outpatientfrom % of charges | $51.89 | $51.89 | $51.89 – $51.89 |
| 10 | MultiPlan multiplan- all plans percent of total billed charges · outpatientfrom % of charges | $100.00 | $100.00 | $100.00 – $100.00 |
| 11 | First Health first health- all plans percent of total billed charges · outpatientfrom % of charges | $102.50 | $102.50 | $102.50 – $102.50 |
| 12 | Cigna cigna- all plans percent of total billed charges · outpatientfrom % of charges | $112.50 | $112.50 | $112.50 – $112.50 |
| 13 | Kaiser kaiser mcal fee schedule · outpatient | $125.00 | $125.00 | $125.00 – $125.00 |
| 14 | Medicaid medi-cal fee schedule · outpatient | $125.00 | $125.00 | $125.00 – $125.00 |
Last updated: Aug 2, 2026
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