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
Illinois
Hospital Address Code Price Last Updated
Alexian Brothers Medical Center 935 Beisner Rd, Elk Grove Village Q9963 $1 [source] 3 years ago
Adventist Hinsdale Hospital 120 N Oak St, Hinsdale Q9963 $1 [source] 3 years ago
St. Alexius Medical Center 1555 Barrington Road, Q9963 $1 [source] 3 years ago
Adventist Lagrange Memorial Hospital 5101 Willow Springs Rd, La Grange Q9963 $1 [source] 3 years ago
Adventist Glenoaks Hospital 701 Winthrop Ave, Glendale Heights Q9963 $1 [source] 3 years ago
Franciscan Health Olympia Fields , Olympia Fields Q9963 $126 [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.