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
Arizona
Hospital Address Code Price Last Updated
Carondelet St. Mary's Hospital 1601 W. St. Mary's Road, Tucson Q9963 $1 [source] 3 years ago
Carondelet St. Joseph's Hospital 350 N. Wilmot Road, Tucson Q9963 $1 [source] 3 years ago
Abrazo West Campus 13677 West Mcdowell Rd., Peoria Q9963 $2 [source] 3 years ago
Abrazo Arrowhead Campus 18701 North 67Th Ave., Glendale Q9963 $4 [source] 3 years ago
Carondelet Holy Cross Hospital 1171 W. Target Range Road, Nogales Q9963 $4 [source] 3 years ago
Valley View Medical Center 5330 South Highway 95, Fort Mohave Q9963 $516 [source] 3 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 ยง180.