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 Wellmark 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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79 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ALEGENT HEALTH - MERCY HOSPITAL, CORNING IOWA Corning, IA fee schedule · inpatient | 2 | $354.60 | $354.60 – $354.60 |
| 2 | ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA Missouri Valley, IA fee schedule · inpatient | 2 | $336.87 | $336.87 – $336.87 |
| 3 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · inpatientfrom % of charges | 1 | $138.94 | $0.82 – $2,707 |
| 4 | Ann & Robert H. Lurie Children's Hospital of Chicago Chicago, IL percent of total billed charges · outpatientfrom % of charges | 1 | $138.94 | $0.82 – $2,707 |
| 5 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $160.86 | $60.35 – $304.39 |
| 6 | Grundy County Memorial Hospital Grundy Center, IA facility · other · outpatient | 1 | $219.52 | $141.34 – $297.70 |
| 7 | Grundy County Memorial Hospital Grundy Center, IA facility · percent of total billed charges · inpatientfrom % of charges | 2 | $2.60 | $0.65 – $3.90 |
| 8 | HAWARDEN REGIONAL HEALTHCARE HARWARDEN, IA other · both | 2 | $95.90 | $1.52 – $228.65 |
| 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 | 2 | $22.00 | $22.00 – $22.00 |
| 17 | Mercy Health Services-Iowa Corp. Mason City, IA facility · fee schedule · outpatient | 2 | $356.43 | $356.43 – $356.43 |
| 18 | Mercy Health Services-Iowa Corp. Mason City, IA facility · other · outpatient | 1 | $372.20 | $372.20 – $372.20 |
| 19 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $112.11 | $4.77 – $273.63 |
| 20 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $107.30 | $6.51 – $327.81 |
| 21 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $186.59 | $46.42 – $409.36 |
| 22 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · case rate · both | 1 | $125.00 | $125.00 – $125.00 |
| 23 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · percent of total billed charges · bothfrom % of charges | 1 | $49.00 | $49.00 – $49.00 |
| 24 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $64.67 | $56.84 – $72.50 |
| 25 | MercyOne Genesis Aledo Medical Center Aledo, IL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $52.41 | $46.06 – $58.75 |
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