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%-NACL 0.45% BOLUS IV WRAPPER
Guthrie, OK
See all hospitals reporting RC 258 →Price type
Mercy Hospital Logan County Inc’s median price of $55 is 46% above the median hospital's median price ($38), higher than 63% 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: 16 payers, 33 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 | Tricare hb lgnok tricare facility · percent of total billed charges · outpatientfrom % of charges | $17.35 | $68.53 | $2.73 – $200.25 |
| 2 | UnitedHealthcare hb lgnok uhc medicare new 040122 w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $17.84 | $70.50 | $2.81 – $206.02 |
| 3 | Ambetter hb lgnok ambetter exchange medicare facility · percent of total billed charges · outpatientfrom % of charges | $20.98 | $82.91 | $3.30 – $242.28 |
| 4 | Aetna hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $25.18 | $99.49 | $3.96 – $290.74 |
| 5 | Blue Cross Blue Shield hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $25.18 | $99.49 | $3.96 – $290.74 |
| 6 | First Health hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $25.18 | $99.49 | $3.96 – $290.74 |
| 7 | Humana hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $25.18 | $99.49 | $3.96 – $290.74 |
| 8 | UnitedHealthcare hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $25.18 | $99.49 | $3.96 – $290.74 |
| 9 | WellCare hb lgnok managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $25.18 | $99.49 | $3.96 – $290.74 |
| 10 | Medica hb lgnok medica medicare new 031523 facility · percent of total billed charges · outpatientfrom % of charges | $25.39 | $100.32 | $3.99 – $293.16 |
| 11 | Medicare hb lgnok medicare facility · percent of total billed charges · outpatientfrom % of charges | $25.39 | $100.32 | $3.99 – $293.16 |
| 12 | Cigna hb lgnok cigna mcr w/seq 103% facility · percent of total billed charges · outpatientfrom % of charges | $26.11 | $103.16 | $4.11 – $301.48 |
| 13 | Blue Cross Blue Shield hb lgnok bcbs of ok nativeblue mcr 103% (no seq) facility · percent of total billed charges · outpatientfrom % of charges | $26.66 | $105.32 | $4.19 – $307.78 |
| 14 | Devoted hb lgnok devoted health mcr 104% w/o seq facility · percent of total billed charges · outpatientfrom % of charges | $29.83 | $117.84 | $4.69 – $344.36 |
| 15 | Blue Cross Blue Shield hb lgnok blue cross advantage ppo facility · percent of total billed charges · outpatientfrom % of charges | $34.97 | $138.18 | $5.50 – $403.80 |
| 16 | Blue Cross Blue Shield hb lgnok blue cross preferred facility · percent of total billed charges · outpatientfrom % of charges | $34.97 | $138.18 | $5.50 – $403.80 |
| 17 | Blue Cross Blue Shield hb lgnok blue lincs facility · percent of total billed charges · outpatientfrom % of charges | $34.97 | $138.18 | $5.50 – $403.80 |
| 18 | Blue Cross Blue Shield hb lgnok blue traditional facility · percent of total billed charges · outpatientfrom % of charges | $34.97 | $138.18 | $5.50 – $403.80 |
| 19 | Medica hb lgnok medica exchange mcr 136% no seq facility · percent of total billed charges · outpatientfrom % of charges | $34.97 | $138.18 | $5.50 – $403.80 |
| 20 | Anthem hb lgnok blue choice facility · percent of total billed charges · outpatientfrom % of charges | $37.07 | $146.47 | $5.83 – $428.03 |
| 21 | Blue Cross Blue Shield hb lgnok blue choice facility · percent of total billed charges · outpatientfrom % of charges | $37.07 | $146.47 | $5.83 – $428.03 |
| 22 | Aetna hb lgnok aetna nbd facility · percent of total billed charges · outpatientfrom % of charges | $37.63 | $148.68 | $5.92 – $434.49 |
| 23 | Aetna hb lgnok aetna facility · percent of total billed charges · outpatientfrom % of charges | $41.06 | $162.22 | $6.46 – $474.06 |
| 24 | Optum hb lgnok uhc facility · percent of total billed charges · outpatientfrom % of charges | $48.96 | $193.45 | $7.70 – $565.32 |
| 25 | UnitedHealthcare hb hmh lhcp lgnok uhc exchange facility · percent of total billed charges · outpatientfrom % of charges | $48.96 | $193.45 | $7.70 – $565.32 |
Last updated: Jun 11, 2026
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