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
GADOTERATE MEGLUMINE 0.5 MMOL/ML (376.9 MG/ML) INTRAVENOUS SOLUTION
Detroit, MI
See all hospitals reporting RC 255 →Price type
Henry Ford Health System’s median price of $78 is 43% above the median hospital's median price ($54), higher than 57% of the 1,205 hospitals reporting RC 255. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 10 payers, 34 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Aetna commercial facility · other · outpatient | $0.01 | $0.01 | $0.01 – $0.01 |
| 2 | Humana tricare facility · fee schedule · outpatient | $0.14 | $3.51 | $0.07 – $155.50 |
| 3 | Molina medicaid hmo facility · fee schedule · outpatient | $0.08 | $65.93 | $0.04 – $1,130 |
| 4 | WellCare medicare advantage facility · fee schedule · outpatient | $0.15 | $86.97 | $0.07 – $2,001 |
| 5 | Aetna commercial facility · fee schedule · outpatient | $115.22 | $94.17 | $52.06 – $115.22 |
| 6 | Molina dual mi coordinated health facility · percent of total billed charges · outpatientfrom % of charges | $58.55 | $113.82 | $2.53 – $1,290 |
| 7 | Blue Cross Blue Shield bcbsm gm connected care facility · fee schedule · outpatient | $0.22 | $161.13 | $0.10 – $2,818 |
| 8 | Blue Cross Blue Shield bcbsm commercial facility · fee schedule · outpatient | $0.28 | $203.62 | $0.13 – $3,562 |
| 9 | Blue Cross Blue Shield bcn commercial facility · fee schedule · outpatient | $0.28 | $203.62 | $0.13 – $3,562 |
| 10 | Amerihealth Caritas dual products facility · percent of total billed charges · outpatientfrom % of charges | $88.40 | $333.41 | $3.38 – $7,954 |
| 11 | Blue Cross Blue Shield blue cross complete facility · fee schedule · outpatient | $445.40 | $400.50 | $10.86 – $1,046 |
| 12 | Aetna Better Health medicaid hmo facility · fee schedule · outpatient | $454.30 | $408.51 | $11.08 – $1,067 |
| 13 | Amerihealth Caritas dual products facility · fee schedule · outpatient | $168.48 | $473.50 | $9.61 – $1,961 |
| 14 | WellCare wellcare meridian dual align (hmo d-snp) facility · fee schedule · outpatient | $171.92 | $483.16 | $9.81 – $2,001 |
| 15 | Aetna medicare advantage facility · fee schedule · outpatient | $659.93 | $569.09 | $9.80 – $2,001 |
| 16 | Blue Cross Blue Shield bcn advantage facility · fee schedule · outpatient | $659.93 | $569.09 | $9.80 – $2,001 |
| 17 | Molina dual mi coordinated health facility · fee schedule · outpatient | $659.93 | $569.09 | $9.80 – $2,001 |
| 18 | UnitedHealthcare erickson advantage facility · fee schedule · outpatient | $659.93 | $569.09 | $9.80 – $2,001 |
| 19 | UnitedHealthcare vaccn facility · fee schedule · outpatient | $659.93 | $569.09 | $9.80 – $2,001 |
| 20 | Blue Cross Blue Shield medicare plus blue facility · fee schedule · outpatient | $659.93 | $569.10 | $9.81 – $2,001 |
| 21 | Humana medicare advantage facility · fee schedule · outpatient | $666.53 | $574.78 | $9.90 – $2,021 |
| 22 | Aetna dual products facility · fee schedule · outpatient | $725.92 | $626.00 | $10.78 – $2,201 |
| 23 | Cigna all products facility · percent of total billed charges · outpatientfrom % of charges | $146.93 | $903.17 | $4.39 – $30,230 |
| 24 | Cigna transplants commercial facility · percent of total billed charges · outpatientfrom % of charges | $161.06 | $990.01 | $4.81 – $33,137 |
| 25 | Aetna commercial facility · percent of total billed charges · inpatientfrom % of charges | $162.89 | $1,001 | $4.87 – $33,515 |
Last updated: Jun 28, 2026
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