Code: Q9963

Description:

Description: High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Other Descriptions:

GASTROGRAFN PO 367 30ML

HOCM 350-399 IC 1ML

DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION

GASTROVIEW CONTRAST

Gastrografin 66+AC0-10+ACU- 120 Ml

Related codes:

Code: Q9960

Description: High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9961

Description: High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9962

Description: High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9964

Description: High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9965

Description: Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9966

Description: Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9967

Description: Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9968

Description: Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg
HCPCS Category: Temporary codes (limited use and guidelines specific)

Code: Q9969

Description: Tc-99m from non-highly enriched uranium source, full cost recovery add-on, per study dose
HCPCS Category: Temporary codes (limited use and guidelines specific)

Arizona

Hospital	Address	Code	Price	Last Updated
Carondelet St. Mary's Hospital	1601 W. St. Mary's Road, Tucson	Q9963	$1 [source]	4 years ago
Carondelet St. Joseph's Hospital	350 N. Wilmot Road, Tucson	Q9963	$1 [source]	4 years ago
Abrazo West Campus	13677 West Mcdowell Rd., Peoria	Q9963	$2 [source]	4 years ago
Abrazo Arrowhead Campus	18701 North 67Th Ave., Glendale	Q9963	$4 [source]	4 years ago
Carondelet Holy Cross Hospital	1171 W. Target Range Road, Nogales	Q9963	$4 [source]	4 years ago
Valley View Medical Center	5330 South Highway 95, Fort Mohave	Q9963	$516 [source]	4 years ago

ChargemasterDB by Joseph Paul Cohen
A database of US hospital prices based on data made available by the Centers for Medicare & Medicaid Services (CMS), HHS price transparancy rule 45 CFR §180.