RC 255

Pharmacy

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

GADOBUTROL 1 MMOL/ML IV SOLN

Payers reporting RC 255

64 payers file a negotiated rate for this code. Each is shown once, under the terms the most hospitals file it under; rates under different terms (billing class, payment method, setting) are never blended, so open a payer to see them all. Figures are hospital-level averages; the median is across hospitals.

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1	Cigna fee schedule · outpatient · +19 other terms	105	$50.01	$139.35	$0.01 – $10,515
2	UnitedHealthcare fee schedule · outpatient · +29 other terms	101	$42.13	$237.47	$0.01 – $5,074
3	Aetna fee schedule · outpatient · +26 other terms	88	$44.88	$173.85	$0.01 – $14,808
4	Anthem fee schedule · outpatient · +23 other terms	87	$20.49	$590.68	$0.01 – $1,140,825
5	Blue Cross Blue Shield facility · fee schedule · outpatient · +28 other terms	64	$19.29	$299.07	$0.08 – $27,953
6	MultiPlan fee schedule · outpatient · +14 other terms	56	$108.16	$100.90	$0.01 – $989.82
7	Humana fee schedule · outpatient · +21 other terms	55	$52.73	$60.64	$0.01 – $5,074
8	Molina fee schedule · outpatient · +22 other terms	38	$101.52	$40,746	$0.01 – $6,068,322
9	Medcost facility · percent of total billed charges · bothfrom % of charges · +5 other terms	32	$154.15	$161.57	$4.08 – $4,985
10	First Health fee schedule · outpatient · +11 other terms	28	$77.51	$96.56	$0.84 – $4,987
11	Kaiser fee schedule · outpatient · +19 other terms	27	$78.84	$80.75	$0.22 – $2,034
12	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$302.44	$268.48	$14.85 – $2,753
13	WellCare facility · fee schedule · outpatient · +14 other terms	25	$10.30	$185.27	$0.07 – $25,440
14	Beechstreet percent of total billed charges · outpatientfrom % of charges · +4 other terms	23	$319.68	$313.52	$0.18 – $14,340
15	Tricare facility · fee schedule · outpatient · +13 other terms	22	$262.97	$948.72	$0.14 – $83,963
16	Healthcare Highways facility · percent of total billed charges · bothfrom % of charges · +4 other terms	21	$208.33	$191.41	$0.07 – $6,534
17	Highmark facility · fee schedule · outpatient · +12 other terms	21	$1.57	$17.63	$0.08 – $4,266
18	Caresource fee schedule · outpatient · +17 other terms	20	$441.53	$435.71	$0.15 – $2,738
19	Bcbs La fee schedule · outpatient · +4 other terms	18	$1.98	$3.90	$0.08 – $389.75
20	Healthpartners fee schedule · outpatient · +10 other terms	18	$49.67	$43.15	$0.22 – $50.78
21	Medica fee schedule · outpatient · +14 other terms	18	$401.19	$23.29	$0.10 – $656.23
22	Optum other · outpatient · +15 other terms	18	$122.50	$509.05	$0.83 – $934.00
23	Ambetter fee schedule · outpatient · +14 other terms	15	$81.78	$63,909	$0.02 – $6,355,338
24	Phcs fee schedule · inpatient · +10 other terms	15	$493.45	$290.05	$0.01 – $579.18
25	Regence facility · fee schedule · both · +14 other terms	15	$23.49	$31.28	$0.07 – $259.40

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