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 50 % IN WATER (D50W) INTRAVENOUS SYRINGE
Tishomingo, OK
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Mercy Hospital Tishomingo Inc’s median price of $40 is 6% above the median hospital's median price ($38), higher than 52% 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, 34 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 | Ambetter hb tish ambetter exchange medicare facility · percent of total billed charges · outpatientfrom % of charges | $19.50 | $24.05 | $3.30 – $48.83 |
| 2 | Blue Cross Blue Shield hb tish blue cross advantage ppo facility · percent of total billed charges · outpatientfrom % of charges | $20.80 | $25.66 | $3.52 – $52.08 |
| 3 | Blue Cross Blue Shield hb tish blue traditional facility · percent of total billed charges · outpatientfrom % of charges | $24.05 | $29.67 | $4.07 – $60.22 |
| 4 | Anthem hb tish blue choice facility · percent of total billed charges · outpatientfrom % of charges | $28.60 | $35.28 | $4.84 – $71.61 |
| 5 | Blue Cross Blue Shield hb tish blue choice facility · percent of total billed charges · outpatientfrom % of charges | $28.60 | $35.28 | $4.84 – $71.61 |
| 6 | Aetna hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 7 | Blue Cross Blue Shield hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 8 | First Health hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 9 | Humana hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 10 | Medica hb tish medica medicare new 031523 facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 11 | Medicare hb tish medicare facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 12 | Tricare hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 13 | Tricare hb tish tricare facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 14 | UnitedHealthcare hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 15 | WellCare hb tish managed medicare 100% w/seq facility · percent of total billed charges · outpatientfrom % of charges | $29.97 | $36.97 | $5.07 – $75.04 |
| 16 | Cigna hb tish cigna mcr w/seq 103% facility · percent of total billed charges · outpatientfrom % of charges | $30.87 | $38.08 | $5.22 – $77.29 |
| 17 | Blue Cross Blue Shield hb tish blue cross preferred facility · percent of total billed charges · outpatientfrom % of charges | $31.20 | $38.49 | $5.28 – $78.12 |
| 18 | Blue Cross Blue Shield hb tish blue lincs facility · percent of total billed charges · outpatientfrom % of charges | $31.20 | $38.49 | $5.28 – $78.12 |
| 19 | UnitedHealthcare hb tish uhc medicare new 040122 w/seq 98.1% facility · percent of total billed charges · outpatientfrom % of charges | $31.25 | $38.54 | $5.29 – $78.23 |
| 20 | Blue Cross Blue Shield hb tish bcbs of ok nativeblue mcr 103% (no seq) facility · percent of total billed charges · outpatientfrom % of charges | $31.47 | $38.82 | $5.33 – $78.79 |
| 21 | Devoted hb tish devoted health mcr 104% w/o seq facility · percent of total billed charges · outpatientfrom % of charges | $31.77 | $39.19 | $5.38 – $79.55 |
| 22 | Aetna hb tish aetna nbd facility · percent of total billed charges · outpatientfrom % of charges | $40.04 | $49.39 | $6.78 – $100.25 |
| 23 | Medica hb tish medica exhange 136% mcr no seq facility · percent of total billed charges · outpatientfrom % of charges | $41.60 | $51.31 | $7.04 – $104.16 |
| 24 | Aetna hb tish aetna facility · percent of total billed charges · outpatientfrom % of charges | $43.23 | $53.32 | $7.32 – $108.23 |
| 25 | First Health hb tish first health facility · percent of total billed charges · outpatientfrom % of charges | $43.23 | $53.32 | $7.32 – $108.23 |
Last updated: Jun 11, 2026
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