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)

Wisconsin

Hospital	Address	Code	Price	Last Updated
Aspirus Medford Hospital	135 S Gibson St, Medford	Q9967	$2 [source]	4 years ago
Aspirus Langlade Hospital	110 E 5Th Ave, Antigo	Q9967	$2 [source]	4 years ago
Adventhealth Durand	1220 3Rd Ave W, Durand	Q9967	$2 [source]	4 years ago
Aspirus Stevens Point Hospital	5409 Vern Holmes Dr,	Q9967	$60 [source]	4 years ago
Aspirus Wausau Hospital	333 Pine Ridge Blvd, Wausau	Q9967	$60 [source]	4 years ago
Prairie Ridge Health	1515 Park Ave, Columbus	Q9967	$89 [source]	4 years ago
Aspirus Riverview Hospital	410 Dewey St, Wisconsin Rapids	Q9967	$128 [source]	4 years ago
Aspirus Divine Savior Hospital	2817 New Pinery Rd, Portage	Q9967	$191 [source]	4 years ago
Watertown Regional Medical Center	125 Hospital Drive, Watertown	Q9967	$548 [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.