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
Kentucky
Hospital Address Code Price Last Updated
Meadowview Regional Medical Center 989 Medical Park Drive, Maysville Q9963 $10 [source] 3 years ago
Bourbon Community Hospital 9 Linville Drive, Paris Q9963 $17 [source] 3 years ago
Clark Regional Medical Center 175 Hospital Drive, Winchester Q9963 $18 [source] 3 years ago
Logan Memorial Hospital 1625 Nashville Street, Russellville Q9963 $36 [source] 3 years ago
Bluegrass Community Hospital 360 Amsden Avenue, Versailles Q9963 $58 [source] 3 years ago
Fleming County Hospital 55 Foundation Drive, Flemingsburg Q9963 $60 [source] 3 years ago
Georgetown Community Hospital 1140 Lexington Rd, Georgetown Q9963 $407 [source] 3 years ago
Spring View Hospital 320 Loretto Road, Lebanon Q9963 $638 [source] 3 years ago
Lake Cumberland Regional Hospital 305 Langdon Street, Somerset Q9963 $1,334 [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.