Code: Q9967

Description:
Description: Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml
HCPCS Category: Temporary codes (limited use and guidelines specific)
Other Descriptions:
LOCM 300-399 IC 30ML
OMNIPAQUE PO 350 100ML
LOCM 300-399 IC 1ML
LOCM 300-399 IC 200ML
OMNIPAQUE PO 350 50ML
OMNIPAQUE PO 300 50ML
LOCM 300-399 IC 10ML
LOCM 300-399 IC 100ML
LOCM 300-399 IC 75ML
Related codes:
Code: Q9960
HOCM 200-249 IC 1ML
Code: Q9961
HOCM 250-299 IC 50ML
Code: Q9962
HOCM 300-349 IC 50ML
Code: Q9963
GASTROGRAFN PO 367 120ML
Code: Q9964
HOCM 400 OR MORE IC 1ML
Code: Q9965
LOCM 100-199 IC 1ML
Code: Q9966
LOCM 200-299 IC 50ML
Code: Q9968
METHYL BLUE 100 MG INJ
Code: Q9969
TC99M NON-HEU ADD-ON
Arizona
Hospital Address Code Price Last Updated
Carondelet St. Joseph's Hospital 350 N. Wilmot Road, Tucson Q9967 $2 [source] 3 years ago
Abrazo Central Hospital 2000 West Bethany Home Rd., Phoenix Q9967 $4 [source] 3 years ago
Abrazo Arizona Heart Hospital 1930 East Thomas Rd., Phoenix Q9967 $5 [source] 3 years ago
Canyon Vista Medical Center 5700 E. Highway 90, Sierra Vista Q9967 $6 [source] 3 years ago
Abrazo Arrowhead Campus 18701 North 67Th Ave., Glendale Q9967 $17 [source] 3 years ago
Abrazo West Campus 13677 West Mcdowell Rd., Peoria Q9967 $42 [source] 3 years ago
Valley View Medical Center 5330 South Highway 95, Fort Mohave Q9967 $1,260 [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.