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)

Kentucky

Hospital	Address	Code	Price	Last Updated
Meadowview Regional Medical Center	989 Medical Park Drive, Maysville	Q9963	$10 [source]	4 years ago
Bourbon Community Hospital	9 Linville Drive, Paris	Q9963	$17 [source]	4 years ago
Clark Regional Medical Center	175 Hospital Drive, Winchester	Q9963	$18 [source]	4 years ago
Logan Memorial Hospital	1625 Nashville Street, Russellville	Q9963	$36 [source]	4 years ago
Bluegrass Community Hospital	360 Amsden Avenue, Versailles	Q9963	$58 [source]	4 years ago
Fleming County Hospital	55 Foundation Drive, Flemingsburg	Q9963	$60 [source]	4 years ago
Georgetown Community Hospital	1140 Lexington Rd, Georgetown	Q9963	$407 [source]	4 years ago
Spring View Hospital	320 Loretto Road, Lebanon	Q9963	$638 [source]	4 years ago
Lake Cumberland Regional Hospital	305 Langdon Street, Somerset	Q9963	$1,334 [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.