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)

Ohio

Hospital	Address	Code	Price	Last Updated
Euclid Hospital	18901 Lakeshore Blvd., Cleveland	Q9963	$200 [source]	4 years ago
Cleveland Clinic Main Campus	9500 Euclid Ave, Cleveland	Q9963	$200 [source]	4 years ago
Medina Hospital	1000 E. Washington St., Medina	Q9963	$200 [source]	4 years ago
Akron General Lodi Hospital	225 Elyria St., Lodi	Q9963	$200 [source]	4 years ago
Lutheran Hospital	1730 West 25Th Street, Cleveland	Q9963	$200 [source]	4 years ago
Fairview Hospital	18101 Lorain Ave., Cleveland	Q9963	$200 [source]	4 years ago
South Pointe Hospital	20000 Harvard Rd., Cleveland	Q9963	$200 [source]	4 years ago
Hillcrest Hospital	6780 Mayfield Rd., Cleveland	Q9963	$200 [source]	4 years ago
Akron General	1 Akron General Ave., Akron	Q9963	$200 [source]	4 years ago
Marymount Hospital	12300 Mccracken Road, Cleveland	Q9963	$200 [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.