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 Premera 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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42 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | COMMONSPIRIT OREGON Roseburg, OR fee schedule · inpatient | 1 | $22.56 | $1.03 – $159.90 |
| 2 | COMMONSPIRIT OREGON Roseburg, OR fee schedule · outpatient | 1 | $24.01 | $1.09 – $170.15 |
| 3 | Central Washington Health Services Association Wenatchee, WA percent of total billed charges · bothfrom % of charges | 3 | $186.80 | $10.98 – $1,005 |
| 4 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · inpatient | 1 | $1.00 | $1.00 – $1.00 |
| 5 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $1.00 | $1.00 – $1.00 |
| 6 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $635.11 | $77.05 – $4,237 |
| 7 | ENUMCLAW REGIONAL HOSPITAL ASSOCIATION Enumclaw, WA fee schedule · outpatient | 1 | $7.83 | $6.29 – $9.36 |
| 8 | Good Samaritan Hospital Puyallup, WA other · outpatient | 4 | $12.75 | $12.75 – $12.75 |
| 9 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $282.66 | $12.25 – $997.44 |
| 10 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763.00 | $763.00 – $763.00 |
| 11 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $290.37 | $24.01 – $1,007 |
| 12 | Johnson Memorial Hospital Stafford Springs, CT facility · fee schedule · both | 1 | $98.91 | $50.51 – $168.35 |
| 13 | Mercy Health Hackley Campus Muskogen, MI facility · fee schedule · both | 1 | $61.19 | $5.37 – $254.98 |
| 14 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $205.82 | $10.04 – $600.00 |
| 15 | Mercy Health Saint Marys Rockford, MI facility · fee schedule · both | 1 | $27.63 | $9.58 – $48.79 |
| 16 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · both | 1 | $22.00 | $22.00 – $22.00 |
| 17 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · outpatient | 1 | $356.43 | $356.43 – $356.43 |
| 18 | MultiCare Capital Medical Center Lacey, WA other · outpatient | 1 | $12.75 | $12.75 – $12.75 |
| 19 | Public Hospital District NO 2 Skagit County Washington Anacortes, WA facility · fee schedule · both | 1 | $71.41 | $0.33 – $125.83 |
| 20 | Public Hospital District No 4 King County WA Snoqualmie, WA percent of total billed charges · bothfrom % of charges | 1 | $70.07 | $1.81 – $165.04 |
| 21 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $95.43 | $19.91 – $238.61 |
| 22 | Saint Alphonsus Medical Center - Nampa Nampa, ID facility · fee schedule · both | 1 | $59.92 | $15.30 – $102.00 |
| 23 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · fee schedule · both | 1 | $75.59 | $15.30 – $259.40 |
| 24 | Saint Alphonsus Regional Medical Center - Boise Boise, ID facility · percent of total billed charges · bothfrom % of charges | 1 | $4,345 | $4,345 – $4,345 |
| 25 | Samaritan Hospital Troy, NY facility · percent of total billed charges · bothfrom % of charges | 1 | $85.92 | $15.48 – $222.53 |
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