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

Blue Cross Blue Shield rates for RC 255

The hospitals that file a Blue Cross Blue Shield 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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758 hospital rates

#		Plans
1	ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient	2	$66.14	$62.66 – $69.62
2	ADVENTIST HEALTH MENDOCINO COAST Bragg, CA percent of total billed charges · outpatientfrom % of charges	3	$642.94	$445.66 – $905.46
3	ADVENTIST HEALTH TULARE Tulare, CA fee schedule · outpatient	3	$140.97	$59.03 – $191.52
4	ADVENTIST HEALTH TULARE Tulare, CA percent of total billed charges · outpatientfrom % of charges	2	$862.66	$724.04 – $1,001
5	AGH LAVEEN LLC Phoenix, AZ fee schedule · outpatient	3	$16.48	$14.83 – $19.77
6	AGH MESA LLC Mesa, AZ fee schedule · outpatient	3	$16.48	$14.83 – $19.77
7	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · inpatient	4	$206.38	$132.96 – $299.16
8	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · outpatient	4	$206.38	$132.96 – $299.16
9	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · inpatient	1	$282.94	$253.18 – $312.69
10	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · fee schedule · outpatient	1	$282.94	$253.18 – $312.69
11	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · inpatientfrom % of charges	3	$4,549	$0.34 – $83,882
12	ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges	3	$4,898	$0.15 – $100,658
13	ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · inpatient	2	$547.42	$533.38 – $561.45
14	ALEGENT CREIGHTON HEALTH Plainview, NE fee schedule · outpatient	3	$485.11	$360.51 – $561.45
15	ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · outpatient	1	$254.13	$254.13 – $254.13
16	ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient	2	$547.42	$533.38 – $561.45
17	ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · outpatient	2	$547.42	$533.38 – $561.45
18	ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · inpatient	2	$547.42	$533.38 – $561.45
19	ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER Schuyler, NE fee schedule · outpatient	3	$465.41	$301.41 – $561.45
20	Allina Health Systems Shakopee, MN facility · other · outpatient	5	$59.37	$0.58 – $185.31
21	Allina Health Systems Shakopee, MN facility · percent of total billed charges · outpatientfrom % of charges	3	$98.85	$0.79 – $237.01
22	Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · other · outpatient	2	$17.34	$15.76 – $18.92
23	Allina Health Systems MN; 1175 Nininger Road. Hastings, MN facility · percent of total billed charges · outpatientfrom % of charges	2	$85.25	$83.95 – $86.55
24	Allina Health Systems Owatonna, MN facility · other · outpatient	5	$59.37	$0.58 – $185.31
25	Allina Health Systems Owatonna, MN facility · percent of total billed charges · outpatientfrom % of charges	3	$98.85	$0.79 – $237.01

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