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
Florida
Hospital Address Code Price Last Updated
Florida Hospital Carrollwood 7171 N Dale Mabry Hwy, Tampa Q9963 $1 [source] 3 years ago
Adventhealth Tampa 3100 E Fletcher Ave, Tampa Q9963 $1 [source] 3 years ago
Adventhealth Wauchula 735 S 5Th Ave, Wauchula Q9963 $2 [source] 3 years ago
Adventhealth Sebring 4200 Sun N Lake Blvd, Sebring Q9963 $2 [source] 3 years ago
Florida Hospital North Pinellas 1395 S Pinellas Ave, Tarpon Springs Q9963 $2 [source] 3 years ago
Adventhealth Waterman 1000 Waterman Way, Tavares Q9963 $2 [source] 3 years ago
Adventhealth New Smyrna Beach 401 Palmetto St, New Smyrna Beach Q9963 $2 [source] 3 years ago
Adventhealth Ocala 1500 Sw 1St Ave, Ocala Q9963 $2 [source] 3 years ago
Adventhealth Zephyrhills 7050 Gall Blvd, Zephyrhills Q9963 $2 [source] 3 years ago
Adventhealth Deland 701 W. Plymouth Avenue, Deland Q9963 $2 [source] 3 years ago
South Bay Hospital 4016 Sun City Center Blvd, Sun City Center Q9963 $3 [source] 3 years ago
Adventhealth Dade City 13100 Fort King Rd, Dade City Q9963 $10 [source] 3 years ago
Lake City Medical Center 340 Nw Commerce Dr, Lake City Q9963 $26 [source] 3 years ago
West Florida Hospital 8383 N Davis Hwy, Pensacola Q9963 $29 [source] 3 years ago
Hialeah Hospital 651 East 25Th St., Hialeah Q9963 $30 [source] 3 years ago
Putnam Community Medical Center 611 Zeagler Dr, Palatka Q9963 $30 [source] 3 years ago
Wellington Regional Medical Center 10101 Forest Hill Blvd., West Palm Beach Q9963 $57 [source] 3 years ago
Memorial Hospital Of Tampa 2901 W. Swann Avenue, Tampa Q9963 $61 [source] 3 years ago
Medical Center Of Trinity 9330 State Rd 54, New Port Richey Q9963 $61 [source] 3 years ago
Fort Walton Beach Medical Center 1000 Mar Walt Dr, Fort Walton Beach Q9963 $65 [source] 3 years ago
Citrus Memorial Hospital 502 W. Highland Blvd, Inverness Q9963 $66 [source] 3 years ago
Aventura Hospital & Medical Center 20900 Biscayne Blvd, Miami Q9963 $68 [source] 3 years ago
St. Petersburg General Hospital 6500 38Th Ave N, Saint Petersburg Q9963 $70 [source] 3 years ago
Englewood Community Hospital 700 Medical Blvd, Englewood Q9963 $70 [source] 3 years ago
Poinciana Medical Center 325 Cypress Pkwy, Kissimmee Q9963 $75 [source] 3 years ago
Kendall Regional Medical Center 11750 Sw 40 St, Miami Q9963 $81 [source] 3 years ago
Fawcett Memorial Hospital 21298 Olean Blvd, Port Charlotte Q9963 $84 [source] 3 years ago
Osceola Regional Medical Center 700 West Oak St, Kissimmee Q9963 $85 [source] 3 years ago
Capital Regional Medical Center 2626 Capital Medical Blvd, Tallahassee Q9963 $89 [source] 3 years ago
Northwest Medical Center 2801 North State Rd 7, Pompano Beach Q9963 $98 [source] 3 years ago
Westside Regional Medical Center 8201 W Broward Blvd, Fort Lauderdale Q9963 $106 [source] 3 years ago
Manatee Healthcare System 206 Second Street East, Bradenton Q9963 $126 [source] 3 years ago
Lakewood Ranch Medical Center 8330 Lakewood Ranch Boulevard, Bradenton Q9963 $126 [source] 3 years ago
Adventhealth East Orlando 12301 Lake Underhill Rd Suite 219, Orlando Q9963 $130 [source] 3 years ago
Twin Cities Hospital 2190 Hwy 85 N, Niceville Q9963 $159 [source] 3 years ago
Northside Hospital 6000 49Th St North, Saint Petersburg Q9963 $170 [source] 3 years ago
Delray Medical Center 5352 Linton Blvd., Delray Beach Q9963 $182 [source] 3 years ago
Cleveland Clinic Florida - Weston 2950 Cleveland Clinic Boulevard, Fort Lauderdale Q9963 $200 [source] 3 years ago
Adventhealth Celebration 400 Celebration Place Attn: Pharmacare Center Pharmacy , Kissimmee Q9963 $236 [source] 3 years ago
Adventhealth Kissimmee 2501 N. Orange Ave, Orlando Q9963 $236 [source] 3 years ago
Adventhealth South Overland Park 10987 Sheldon Rd Ste 100, Tampa Q9963 $236 [source] 3 years ago
Adventist Health System-Sunbelt Inc 2100 Ocoee Apopka Rd, Apopka Q9963 $236 [source] 3 years ago
Florida Oncology Network Pa 7727 Lake Underhill Rd, Orlando Q9963 $236 [source] 3 years ago
Adventhealth Winter Park 3099 Aloma Ave, Winter Park Q9963 $236 [source] 3 years ago
North Florida Regional Medical Center 6500 W Newberry Rd, Gainesville Q9963 $242 [source] 3 years ago
Memorial Hospital 3625 University Blvd. S, Jacksonville Q9963 $289 [source] 3 years ago
Palms Of Pasadena Hospital 1501 Pasadena Ave, Saint Petersburg Q9963 $301 [source] 3 years ago
Orange Park Medical Center 2001 Kingsley Avenue, Orange Park Q9963 $310 [source] 3 years ago
Central Florida Regional Hospital 1401 West Seminole Blvd, Sanford Q9963 $328 [source] 3 years ago
Raulerson Hospital 1796 Hwy 441 North, Okeechobee Q9963 $360 [source] 3 years ago
St. Lucie Medical Center 1800 Se Tiffany Ave, Port Saint Lucie Q9963 $400 [source] 3 years ago
University Hospital & Medical Center 7201 North University Dr, Fort Lauderdale Q9963 $450 [source] 3 years ago
Plantation General Hospital 401 Nw 42 Ave, Fort Lauderdale Q9963 $502 [source] 3 years ago
Mercy Miami Hospital 3663 S Miami Ave, Miami Q9963 $505 [source] 3 years ago
Oak Hill Hospital 11375 Cortez Blvd, Brooksville Q9963 $519 [source] 3 years ago
Doctors Hospital Of Sarasota 5731 Bee Ridge Rd, Sarasota Q9963 $519 [source] 3 years ago
Ocala Health 1431 Sw 1St Ave, Ocala Q9963 $593 [source] 3 years ago
Palms West Hospital 13001 Southern Blvd, Loxahatchee Q9963 $631 [source] 3 years ago
Highlands Regional Medical Center 3600 South Highlands Ave, Sebring Q9963 $729 [source] 3 years ago
Gulf Coast Regional Medical Center 449 W 23Rd St, Panama City Q9963 $762 [source] 3 years ago
Lawnwood Medical Center & Heart Institute 1700 S 23Rd St, Fort Pierce Q9963 $767 [source] 3 years ago
Rmc Bayonet Point (Level Ii Trauma Center) 14000 Fivay Rd, Hudson Q9963 $772 [source] 3 years ago
Jfk Medical Center 5301 S Congress Ave, Lake Worth Q9963 $1,400 [source] 3 years ago
Jfk Medical Center - North Campus 2201 45Th St, West Palm Beach Q9963 $1,400 [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.