Code: Q9967

Description:

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

Other Descriptions:

LOCM 300-399 IC 30ML

OMNIPAQUE PO 350 100ML

LOCM 300-399 IC 1ML

LOCM 300-399 IC 200ML

OMNIPAQUE PO 350 50ML

OMNIPAQUE PO 300 50ML

LOCM 300-399 IC 10ML

LOCM 300-399 IC 100ML

LOCM 300-399 IC 75ML

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: Q9963

Description: High osmolar contrast material, 350-399 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: 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)

Utah

Hospital	Address	Code	Price	Last Updated
Garfield Memorial Clinic	200 N 400 E, Panguitch	Q9967	$3 [source]	4 years ago
Moab Regional Hospital	450 Williams Way, Moab	Q9967	$142 [source]	4 years ago
Castleview Hospital	300 North Hospital Drive, Price	Q9967	$616 [source]	4 years ago
Mountainstar Healthcare	6985 Union Park Center, Suite 500, Midvale	Q9967	$1,003 [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.