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

Highmark rates for RC 255

The hospitals that file a Highmark 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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101 hospital rates

#		Plans
1	Appalachian Regional Healthcare, Inc. Hinton, WV percent of total billed charges · outpatientfrom % of charges	1	$474.27	$257.87 – $723.84
2	Appalachian Regional Healthcare, Inc. Beckley, WV other · outpatient	2	$671.00	$671.00 – $671.00
3	Armstrong County Memorial Hospital Kittanning, PA facility · percent of total billed charges · outpatientfrom % of charges	1	$20.00	$20.00 – $20.00
4	Broaddus Hospital Association Inc Philippi, WV facility · percent of total billed charges · outpatientfrom % of charges	2	$14.69	$2.14 – $42.36
5	Butler Healthcare Providers_ DBA Butler Memorial Hospital Butler, PA facility · percent of total billed charges · outpatientfrom % of charges	3	$251.34	$1.32 – $3,063
6	Clarion Hospital Clarion, PA facility · percent of total billed charges · outpatientfrom % of charges	2	$157.89	$0.34 – $1,347
7	Davis Medical Center Elkins, WV facility · percent of total billed charges · outpatientfrom % of charges	1	$25.97	$1.15 – $71.93
8	Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient	2	$3,234	$2,202 – $4,266
9	ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · both	4	$1.74	$0.15 – $16.71
10	Ephrata Community Hospital Ephrata, PA fee schedule · outpatient	1	$7.51	$0.28 – $14.73
11	Evangelical Community Hospital Lewisburg, PA fee schedule · outpatient	1	$14.73	$14.73 – $14.73
12	Fox Chase Cancer Center Philadelphia, PA facility · fee schedule · outpatient	2	$1.57	$0.08 – $48.78
13	Fox Chase Cancer Center Philadelphia, PA facility · percent of total billed charges · outpatientfrom % of charges	2	$18.72	$10.73 – $33.29
14	Gettysburg Hospital Gettysburg, PA fee schedule · outpatient	1	$7.51	$0.28 – $14.73
15	Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges	1	$282.66	$12.25 – $997.44
16	Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both	1	$763.00	$763.00 – $763.00
17	Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges	1	$290.37	$24.01 – $1,007
18	Johnson Memorial Hospital Stafford Springs, CT facility · fee schedule · both	1	$98.91	$50.51 – $168.35
19	Lancaster General Health Lancaster, PA facility · other · outpatient	5	$62.57	$0.01 – $513.16
20	Lancaster General Health Lancaster, PA facility · percent of total billed charges · inpatientfrom % of charges	5	$86.36	$0.01 – $509.00
21	Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both	1	$61.19	$5.37 – $254.98
22	Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges	1	$205.82	$10.04 – $600.00
23	Mercy Health Saint Marys Rockford, MI facility · fee schedule · both	1	$27.63	$9.58 – $48.79
24	Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · both	1	$22.00	$22.00 – $22.00
25	Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · outpatient	1	$356.43	$356.43 – $356.43

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