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
Georgia
Hospital Address Code Price Last Updated
Murray Medical Center, Inc. 104 Hospital Dr, Chatsworth Q9963 $1 [source] 3 years ago
Adventist Health System Georgia, Inc 170 Curtis Pkwy Ne, Calhoun Q9963 $1 [source] 3 years ago
Adventhealth Gordon 105 Willowbrook Way Se, Calhoun Q9963 $1 [source] 3 years ago
Adventist Health System Georgia Inc 1035 Red Bud Rd Ne, Calhoun Q9963 $1 [source] 3 years ago
Murray County Memorial Hospital Authority 707 Old Dalton Ellijay Rd, Chatsworth Q9963 $2 [source] 3 years ago
Wellstar Atlanta Medical Center 303 Parkway Dr Ne, Atlanta, Georgia, Atlanta Q9963 $2 [source] 3 years ago
Memorial Health 4700 Waters Avenue, Savannah Q9963 $161 [source] 3 years ago
Redmond Regional Medical Center 501 Redmond Rd, Rome Q9963 $180 [source] 3 years ago
Eastside Medical Center 1700 Medical Way, Snellville Q9963 $249 [source] 3 years ago
Emory University Hospital Decatur 2165 N Decatur Rd , Decatur Q9963 $255 [source] 3 years ago
Fairview Park Hospital 200 Industrial Boulevard, Dublin Q9963 $276 [source] 3 years ago
Coliseum Health System 350 Hospital Dr, Macon Q9963 $279 [source] 3 years ago
Cartersville Medical Center 960 Joe Frank Harris Pkwy, Cartersville Q9963 $1,067 [source] 3 years ago
Doctors Hospital Of Augusta 3651 Wheeler Rd, Augusta Q9963 $1,227 [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.