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
HOCM 200-249 IC 1ML
Code: Q9961
HOCM 250-299 IC 50ML
Code: Q9962
HOCM 300-349 IC 50ML
Code: Q9964
HOCM 400 OR MORE IC 1ML
Code: Q9965
LOCM 100-199 IC 1ML
Code: Q9966
LOCM 200-299 IC 50ML
Code: Q9967
LOCM 300-399 IC 50ML
Code: Q9968
METHYL BLUE 100 MG INJ
Code: Q9969
TC99M NON-HEU ADD-ON
State Average # Hospitals In Database
West Virginia (WV) $2 1
Maryland (MD) $3 3
Colorado (CO) $8 3
New York (NY) $9 1
Pennsylvania (PA) $17 1
Maine (ME) $21 2
Illinois (IL) $22 6
Massachusetts (MA) $24 3
Iowa (IA) $35 3
Nebraska (NE) $37 6
Wisconsin (WI) $58 18
Alaska (AK) $61 2
Virginia (VA) $66 6
Michigan (MI) $85 12
Arizona (AZ) $88 6
Vermont (VT) $90 1
Hawaii (HI) $95 1
New Mexico (NM) $111 2
Texas (TX) $111 49
District of Columbia (DC) $117 1
Oklahoma (OK) $122 1
Idaho (ID) $137 5
California (CA) $149 48
Missouri (MO) $171 6
Utah (UT) $171 4
Tennessee (TN) $192 6
Indiana (IN) $192 13
Ohio (OH) $200 10
Georgia (GA) $217 19
South Carolina (SC) $241 8
Florida (FL) $246 101
Connecticut (CT) $252 4
Nevada (NV) $272 12
Kentucky (KY) $286 9
Alabama (AL) $373 1
Kansas (KS) $462 5
Wyoming (WY) $466 2
North Carolina (NC) $467 10
Louisiana (LA) $800 2
New Hampshire (NH) $855 2

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 ยง180.