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
Texas
Hospital Address Code Price Last Updated
Adventhealth Rollins Brook 608 N Key Ave, Lampasas Q9963 $3 [source] 3 years ago
Adventhealth Central Texas 2201 Clear Creek Rd, Killeen Q9963 $3 [source] 3 years ago
Corpus Christi Medical Center 7101 South Padre Island Dr, Corpus Christi Q9963 $4 [source] 3 years ago
Texas Children's Hospital 6621 Fannin St Houston, Houston Q9963 $4 [source] 3 years ago
Texas Health Huguley 11801 South Fwy, Burleson Q9963 $7 [source] 3 years ago
Baylor Scott & White Medical Center - Marble Falls 810 W. State Highway 71, Marble Falls Q9963 $17 [source] 3 years ago
Baylor Scott & White Medical Center - Taylor 305 Mallard Ln, Taylor Q9963 $17 [source] 3 years ago
Baylor Scott & White Medical Center - College Station 700 Scott And White Dr, College Station Q9963 $17 [source] 3 years ago
Baylor Scott & White Medical Center - Brenham 700 Medical Pkwy, Brenham Q9963 $17 [source] 3 years ago
Baylor Scott & White Medical Center - Buda 5330 Overpass Rd, Buda Q9963 $20 [source] 3 years ago
Baylor Scott & White Medical Center - Pflugerville 2600 E Pflugerville Pkwy Ste 100, Pflugerville Q9963 $20 [source] 3 years ago
Baylor Scott & White Medical Center - Round Rock 300 University Blvd, Sandy Q9963 $20 [source] 3 years ago
Baylor Scott & White Medical Center - Lakeway 100 Medical Pkwy, Austin Q9963 $20 [source] 3 years ago
Paris Regional Medical Center 865 Deshong Drive, Paris Q9963 $23 [source] 3 years ago
Baylor Scott & White Medical Center - Irving 1901 N Macarthur Blvd, Irving Q9963 $25 [source] 3 years ago
Baylor Scott & White Medical Center - Plano 4700 Alliance Blvd, Plano Q9963 $25 [source] 3 years ago
Baylor Scott & White Emergency Hospital - Murphy 511 W Fm 544 Ste 100, Plano Q9963 $25 [source] 3 years ago
Baylor Scott & White Heart And Vascular Hospital - Dallas 621 N Hall St, Dallas Q9963 $25 [source] 3 years ago
Baylor Scott & White All Saints Medical Center - Fort Worth 1400 8Th Ave, Fort Worth Q9963 $25 [source] 3 years ago
Baylor Scott & White Medical Center - Centennial 12505 Lebanon Rd, Frisco Q9963 $25 [source] 3 years ago
Baylor Scott & White Emergency Center - Forney 757 E Us Highway 80 Ste 150, Forney Q9963 $25 [source] 3 years ago
Baylor Scott & White The Heart Hospital - Plano 1100 Allied Dr, Plano Q9963 $25 [source] 3 years ago
Baylor Scott & White Continuing Care Hospital - Temple 546 N Kegley Rd, Temple Q9963 $25 [source] 3 years ago
Baylor Scott & White Emergency Hospital - Aubrey 26791 Us Highway 380 E, Aubrey Q9963 $25 [source] 3 years ago
Baylor Scott & White Medical Center - Grapevine 1650 W College St, Grapevine Q9963 $25 [source] 3 years ago
Baylor Scott & White Medical Center - Waxahachie 2400 N Interstate 35E, Waxahachie Q9963 $25 [source] 3 years ago
Baylor Scott & White Medical Center - Lake Pointe 6800 Scenic Dr, Rowlett Q9963 $25 [source] 3 years ago
Baylor Scott & White The Heart Hospital - Denton 2801 S Mayhill Rd, Denton Q9963 $25 [source] 3 years ago
Medical City Fort Worth 900 8Th Ave, Fort Worth Q9963 $36 [source] 3 years ago
South Texas Health System Children’s 1102 W. Trenton Road, Edinburg Q9963 $52 [source] 3 years ago
South Texas Health System Heart 1900 South D Street, Mcallen Q9963 $52 [source] 3 years ago
South Texas Health System Mcallen 301 W. Expressway 83, Mcallen Q9963 $52 [source] 3 years ago
Palestine Regional Medical Center 2900 South Loop 256, Palestine Q9963 $128 [source] 3 years ago
Fort Duncan Regional Medical Center 3333 N. Foster Maldonado Blvd., Eagle Pass Q9963 $146 [source] 3 years ago
Ennis Regional Medical Center 2201 West Lampasas, Waxahachie Q9963 $198 [source] 3 years ago
Woman's Hospital Of Texas 7600 Fannin, Houston Q9963 $240 [source] 3 years ago
Texoma Medical Center 5016 South Us Highway 75, Denison Q9963 $243 [source] 3 years ago
Medical City North Hills 4401 Booth Calloway Rd, North Richland Hills Q9963 $292 [source] 3 years ago
Hca Houston Healthcare 3737 Buffalo Speedway Suite 140, Houston Q9963 $302 [source] 3 years ago
Rio Grande Regional Hospital 101 East Ridge Road, Mcallen Q9963 $311 [source] 3 years ago
Medical City Dallas 13155 Noel Rd. Suite 200, Dallas Q9963 $512 [source] 3 years ago
St. David's Healthcare , Round Rock Q9963 $703 [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 §180.