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
GADOBUTROL 1 MMOL/ML IV SOLN
The hospitals that file a Amerihealth Caritas rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.
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76 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $313.41 | $17.03 – $4,859 |
| 2 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 1 | $50.12 | $0.63 – $811.75 |
| 3 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 1 | $40.07 | $0.51 – $648.94 |
| 4 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 1 | $53.14 | $0.67 – $860.65 |
| 5 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $77.47 | $0.98 – $1,255 |
| 6 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $77.47 | $0.98 – $1,255 |
| 7 | Carolinas Medical Center Davidson, NC percent of total billed charges · outpatientfrom % of charges | 1 | $77.47 | $0.98 – $1,255 |
| 8 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $77.47 | $0.98 – $1,255 |
| 9 | Chambersburg Hospital Chambersburg, PA fee schedule · outpatient | 1 | $900.16 | $900.16 – $900.16 |
| 10 | Children's Hospital of the King's Daughters Norfolk, VA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $61.86 | $13.02 – $140.41 |
| 11 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $149.16 | $13.65 – $301.80 |
| 12 | Ephrata Community Hospital Ephrata, PA fee schedule · outpatient | 1 | $7.51 | $0.28 – $14.73 |
| 13 | Evangelical Community Hospital Lewisburg, PA fee schedule · outpatient | 1 | $14.73 | $14.73 – $14.73 |
| 14 | Gettysburg Hospital Gettysburg, PA fee schedule · outpatient | 1 | $7.51 | $0.28 – $14.73 |
| 15 | HOSPITAL SERVICE DISTRICT #2 OF LASALLE PARISH JENA, LA fee schedule · both | 1 | $1.44 | $1.28 – $1.92 |
| 16 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 1 | $473.50 | $9.61 – $1,961 |
| 17 | Henry Ford Health System West Bloomfield, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $333.41 | $3.38 – $7,954 |
| 18 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 1 | $473.50 | $9.61 – $1,961 |
| 19 | Henry Ford Health System Plymouth, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $333.41 | $3.38 – $7,954 |
| 20 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 1 | $473.50 | $9.61 – $1,961 |
| 21 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $333.41 | $3.38 – $7,954 |
| 22 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 1 | $473.50 | $9.61 – $1,961 |
| 23 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $333.41 | $3.38 – $7,954 |
| 24 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $271.99 | $11.79 – $959.79 |
| 25 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $279.41 | $23.10 – $968.79 |
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