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
California
Hospital Address Code Price Last Updated
Jfk Memorial Hospital 47-111 Monroe St., Indio Q9963 $3 [source] 3 years ago
Sierra Vista Regional Medical Center 1010 Murray Ave., San Luis Obispo Q9963 $3 [source] 3 years ago
Vallejo Medical Center 975 Sereno Dr, Vallejo Q9963 $4 [source] 3 years ago
Vacaville Medical Center 1 Quality Dr, Vacaville Q9963 $4 [source] 3 years ago
San Leandro Medical Center 2500 Merced St, San Leandro Q9963 $4 [source] 3 years ago
Walnut Creek Medical Center 1425 S Main St, Walnut Creek Q9963 $4 [source] 3 years ago
Modesto Medical Center 4601 Dale Rd, Modesto Q9963 $4 [source] 3 years ago
Santa Clara Medical Center 700 Lawrence Expy, Santa Clara Q9963 $4 [source] 3 years ago
South Sacramento Medical Center 6600 Bruceville Rd, Sacramento Q9963 $4 [source] 3 years ago
Richmond Medical Center 901 Nevin Ave, Richmond Q9963 $4 [source] 3 years ago
Santa Rosa Medical Center 401 Bicentennial Way, American Canyon Q9963 $4 [source] 3 years ago
Redwood City Medical Center 1100 Veterans Blvd, Redwood City Q9963 $4 [source] 3 years ago
San Rafael Medical Center 99 Montecillo Rd, San Rafael Q9963 $4 [source] 3 years ago
South San Francisco Medical Center 1200 El Camino Real, South San Francisco Q9963 $4 [source] 3 years ago
Oakland Medical Center 3600 Broadway, Woodland Hills Q9963 $4 [source] 3 years ago
Sacramento Medical Center 2025 Morse Ave, Sacramento Q9963 $4 [source] 3 years ago
San Jose Medical Center 250 Hospital Pkwy, San Jose Q9963 $4 [source] 3 years ago
Roseville Medical Center 1600 Eureka Rd, Roseville Q9963 $4 [source] 3 years ago
Fresno Medical Center 39400 Paseo Padre Pkwy, Fresno Q9963 $4 [source] 3 years ago
Kaiser Foundation Hospitals 4501 Sand Creek Road, Antioch Q9963 $4 [source] 3 years ago
San Francisco Medical Center 2525 Geary Blvd, San Francisco Q9963 $4 [source] 3 years ago
West Los Angeles Medical Center 6041 Cadillac Ave, Los Angeles Q9963 $5 [source] 3 years ago
Irvine Medical Center 6640 Alton Pkwy, Irvine Q9963 $5 [source] 3 years ago
Ontario Medical Center 2295 S Vineyard Ave, Ontario Q9963 $5 [source] 3 years ago
Downey Medical Center 9333 Imperial Hwy, Downey Q9963 $5 [source] 3 years ago
Baldwin Park Medical Center 1011 Baldwin Park Blvd, Baldwin Park Q9963 $5 [source] 3 years ago
Los Angeles Medical Center 4867 W Sunset Blvd, Los Angeles Q9963 $5 [source] 3 years ago
Anaheim Medical Center 3440 E La Palma Ave, Anaheim Q9963 $5 [source] 3 years ago
Zion Medical Center 4647 Zion Ave, San Diego Q9963 $5 [source] 3 years ago
Moreno Valley Medical Center 27300 Iris Ave., Moreno Valley Q9963 $5 [source] 3 years ago
Panorama City Medical Center 13651 Willard St, Panorama City Q9963 $5 [source] 3 years ago
Fontana Medical Center 9961 Sierra Ave, Fontana Q9963 $5 [source] 3 years ago
South Bay Medical Center 25825 Vermont Ave, Harbor City Q9963 $5 [source] 3 years ago
Riverside Medical Center 10800 Magnolia Ave, Riverside Q9963 $5 [source] 3 years ago
Woodland Hills Medical Center 5601 De Soto Ave, Woodland Hills Q9963 $5 [source] 3 years ago
Emanuel Medical Center 825 Delbon Avenue, Turlock Q9963 $7 [source] 3 years ago
Fountain Valley Regional Hospital 17100 Euclid At Warner, Fountain Valley Q9963 $11 [source] 3 years ago
Lakewood Regional Medical Center 3700 East South St., Lakewood Q9963 $35 [source] 3 years ago
Los Robles Regional Medical Center 215 West Janss Rd, Thousand Oaks Q9963 $66 [source] 3 years ago
Riverside Community Hospital 4445 Magnolia Ave, Riverside Q9963 $159 [source] 3 years ago
West Hills Hospital 7300 Medical Center Dr, West Hills Q9963 $229 [source] 3 years ago
Regional Medical Center Of San Jose 225 North Jackson Ave, San Jose Q9963 $1,400 [source] 3 years ago
Cedars-Sinai Medical Center 8700 Beverly Blvd, Los Angeles Q9963 $3,250 [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.