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
Wisconsin
Hospital Address Code Price Last Updated
Chippewa Valley Hospital & Oakview Care Center, Inc. 1220 3Rd Ave W, Durand Q9963 $3 [source] 3 years ago
Aurora Baycare 1160 Kepler Dr, Green Bay Q9963 $31 [source] 3 years ago
Aurora Medical Center Of Manitowoc County 5000 Memorial Dr, Two Rivers Q9963 $32 [source] 3 years ago
Aurora Medical Center Summit 36500 Aurora Dr, Oconomowoc Q9963 $34 [source] 3 years ago
Aurora West Allis Medical Center 8901 W Lincoln Ave, Milwaukee Q9963 $36 [source] 3 years ago
Aurora St Luke's South Shore 5900 S Lake Dr, Cudahy Q9963 $39 [source] 3 years ago
Aurora Medical Center Grafton 975 Port Washington Road, Grafton Q9963 $39 [source] 3 years ago
Aurora Lakeland Medical Center W3930 County Road Nn, Elkhorn Q9963 $50 [source] 3 years ago
Aurora Medical Center Burlington 252 Mchenry St, Burlington Q9963 $50 [source] 3 years ago
Aurora Sinai Medical Center 945 N 12Th St, Milwaukee Q9963 $52 [source] 3 years ago
Aurora St. Luke's Medical Center 2900 W Oklahoma Ave, Milwaukee Q9963 $53 [source] 3 years ago
Aurora Medical Center Of Oshkosh 855 N Westhaven Dr, Oshkosh Q9963 $57 [source] 3 years ago
Aurora Medical Center Kenosha 10400 75Th St, Kenosha Q9963 $60 [source] 3 years ago
Aurora Sheboygan Memorial Medical Center 2629 N 7Th St, Sheboygan Q9963 $68 [source] 3 years ago
Aurora Medical Center Of Washington County 1032 E Sumner St, Hartford Q9963 $86 [source] 3 years ago
Watertown Regional Medical Center 125 Hospital Drive, Watertown Q9963 $163 [source] 3 years ago
Aspirus Divine Savior Hospital 2817 New Pinery Rd, Portage Q9963 $191 [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.