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
Tennessee
Hospital Address Code Price Last Updated
Southern Tennessee Regional Health System - Lawrenceburg 1607 South Locust Avenue, Lawrenceburg Q9963 $3 [source] 3 years ago
Southern Tennessee Regional Health System - Winchester 185 Hospital Road, Winchester Q9963 $3 [source] 3 years ago
Riverview Regional Medical Center 158 Hospital Drive, Carthage Q9963 $19 [source] 3 years ago
Sumner Regional Medical Center 555 Hartsville Pike, Gallatin Q9963 $51 [source] 3 years ago
Trousdale Medical Center 500 Church Street, Hartsville Q9963 $99 [source] 3 years ago
Southern Tennessee Regional Health System - Pulaski 1265 East College Street, Pulaski Q9963 $977 [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.