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

Clover rates for RC 255

The hospitals that file a Clover 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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34 hospital rates

#		Plans
1	Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient	1	$9.91	$9.91 – $9.91
2	East Cooper Medical Center LLC Mt Pleasant, SC percent of total billed charges · bothfrom % of charges	2	$29.32	$0.30 – $244.80
3	Foley Hospital Company LLC Foley, AL facility · fee schedule · outpatient	1	$9.84	$9.39 – $9.91
4	Gadsden Regional Medical Center LLC Gadsden, AL facility · fee schedule · outpatient	1	$9.91	$9.91 – $9.91
5	HMH HOSPITALS CORPORATION Hackensack, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
6	HMH HOSPITALS CORPORATION Red Bank, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
7	HMH HOSPITALS CORPORATION Manahawkin, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
8	HMH HOSPITALS CORPORATION Neptune City, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
9	HMH HOSPITALS CORPORATION Edison, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
10	HMH HOSPITALS CORPORATION North Bergen, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
11	HMH HOSPITALS CORPORATION Holmdel, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
12	HMH HOSPITALS CORPORATION Old Bridge, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
13	HMH HOSPITALS CORPORATION Point Pleasant, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
14	HMH HOSPITALS CORPORATION Perth Amboy, NJ facility · percent of total billed charges · outpatientfrom % of charges	1	$36.33	$36.33 – $36.33
15	Hackensack Meridian at Pascack Valley Westwood, NJ facility · percent of total billed charges · bothfrom % of charges	1	$58.56	$0.03 – $425.11
16	Hilton Head Medical Center LLC Hilton Head Island, SC percent of total billed charges · bothfrom % of charges	2	$18.26	$0.10 – $173.40
17	Northside Hospital, Inc. Lawrenceville, GA fee schedule · outpatient	1	$1,254	$1,254 – $1,254
18	Northside Hospital, Inc. Atlanta, GA fee schedule · outpatient	1	$1,254	$1,254 – $1,254
19	Northside Hospital, Inc. Cumming, GA fee schedule · outpatient	1	$1,254	$1,254 – $1,254
20	Northside Hospital, Inc. Duluth, GA fee schedule · outpatient	1	$1,254	$1,254 – $1,254
21	Northside Hospital, Inc. Canton, GA fee schedule · outpatient	1	$1,254	$1,254 – $1,254
22	Northwest Hospital LLC Tucson, AZ facility · fee schedule · outpatient	1	$9.91	$9.91 – $9.91
23	Northwest Sahurita Hospital LLC Tucson, AZ facility · fee schedule · outpatient	1	$9.91	$9.91 – $9.91
24	Northwest Sahurita Hospital LLC Sahuarita, AZ facility · fee schedule · outpatient	1	$9.91	$9.91 – $9.91
25	Oro Valley Hospital LLC Tucson, AZ facility · fee schedule · outpatient	1	$9.91	$9.91 – $9.91

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