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
Texas
Hospital Address Code Price Last Updated
Texas Children's Hospital 6621 Fannin St Houston, Houston Q9967 $4 [source] 3 years ago
Texoma Medical Center 5016 South Us Highway 75, Denison Q9967 $4 [source] 3 years ago
The Hospitals Of Providence Sierra Campus 1625 Medical Center Dr., El Paso Q9967 $5 [source] 3 years ago
Adventhealth Rollins Brook 608 N Key Ave, Lampasas Q9967 $7 [source] 3 years ago
Valley Baptist Medical Center 2101 Pease Street, Harlingen Q9967 $7 [source] 3 years ago
Nacogdoches Medical Center 4920 Ne Stallings Dr., Nacogdoches Q9967 $7 [source] 3 years ago
Texas Health Huguley 11801 South Fwy, Burleson Q9967 $12 [source] 3 years ago
The Hospitals Of Providence Memorial Campus 2001 North Oregon, El Paso Q9967 $12 [source] 3 years ago
Medical City Las Colinas 6800 N Macarthur Blvd, Irving Q9967 $13 [source] 3 years ago
Medical City Lewisville 500 W Main St, Lewisville Q9967 $20 [source] 3 years ago
Valley Baptist Medical Center 1040 West Jefferson, Brownsville Q9967 $23 [source] 3 years ago
The Hospitals Of Providence Transmountain Campus 2000 Transmountain Road, El Paso Q9967 $28 [source] 3 years ago
The Hospitals Of Providence East Campus 3280 Joe Battle Blvd., El Paso Q9967 $34 [source] 3 years ago
Medical City Frisco 5500 Frisco Square Blvd, Frisco Q9967 $82 [source] 3 years ago
Medical City Arlington 3301 Matlock Rd, Arlington Q9967 $82 [source] 3 years ago
South Texas Health System Children’s 1102 W. Trenton Road, Edinburg Q9967 $110 [source] 3 years ago
South Texas Health System Heart 1900 South D Street, Mcallen Q9967 $110 [source] 3 years ago
South Texas Health System Mcallen 301 W. Expressway 83, Mcallen Q9967 $110 [source] 3 years ago
Baylor Scott & White Medical Center - Brenham 700 Medical Pkwy, Brenham Q9967 $139 [source] 3 years ago
Baylor Scott & White Medical Center - Taylor 305 Mallard Ln, Taylor Q9967 $139 [source] 3 years ago
Baylor Scott & White Medical Center - Marble Falls 810 W. State Highway 71, Marble Falls Q9967 $139 [source] 3 years ago
Baylor Scott & White Medical Center - College Station 700 Scott And White Dr, College Station Q9967 $139 [source] 3 years ago
St. Luke's Baptist Hospital 7930 Floyd Curl Dr., San Antonio Q9967 $149 [source] 3 years ago
Baptist Medical Center 111 Dallas St., San Antonio Q9967 $149 [source] 3 years ago
Northeast Baptist Hospital 8811 Village Dr., San Antonio Q9967 $149 [source] 3 years ago
North Central Baptist Hospital 520 Madison Oak Dr., San Antonio Q9967 $149 [source] 3 years ago
Mission Trail Baptist Hospital 3333 Research Plaza, San Antonio Q9967 $149 [source] 3 years ago
Medical City Alliance 3101 N Tarrant Pkwy, Fort Worth Q9967 $162 [source] 3 years ago
Baylor Scott & White Medical Center - Pflugerville 2600 E Pflugerville Pkwy Ste 100, Pflugerville Q9967 $167 [source] 3 years ago
Baylor Scott & White Medical Center - Round Rock 300 University Blvd, Sandy Q9967 $167 [source] 3 years ago
Baylor Scott & White Medical Center - Lakeway 100 Medical Pkwy, Austin Q9967 $167 [source] 3 years ago
Baylor Scott & White Medical Center - Buda 5330 Overpass Rd, Buda Q9967 $167 [source] 3 years ago
Baylor Scott & White All Saints Medical Center - Fort Worth 1400 8Th Ave, Fort Worth Q9967 $209 [source] 3 years ago
Baylor Scott & White Medical Center - Plano 4700 Alliance Blvd, Plano Q9967 $209 [source] 3 years ago
Baylor Scott & White Emergency Hospital - Murphy 511 W Fm 544 Ste 100, Plano Q9967 $209 [source] 3 years ago
Baylor Scott & White Emergency Center - Forney 757 E Us Highway 80 Ste 150, Forney Q9967 $209 [source] 3 years ago
Baylor Scott & White Heart And Vascular Hospital - Dallas 621 N Hall St, Dallas Q9967 $209 [source] 3 years ago
Baylor Scott & White The Heart Hospital - Plano 1100 Allied Dr, Plano Q9967 $209 [source] 3 years ago
Baylor Scott & White Medical Center - Centennial 12505 Lebanon Rd, Frisco Q9967 $209 [source] 3 years ago
Baylor Scott & White Continuing Care Hospital - Temple 546 N Kegley Rd, Temple Q9967 $209 [source] 3 years ago
Baylor Scott & White Medical Center - Irving 1901 N Macarthur Blvd, Irving Q9967 $209 [source] 3 years ago
Baylor Scott & White Medical Center - Grapevine 1650 W College St, Grapevine Q9967 $209 [source] 3 years ago
Baylor Scott & White The Heart Hospital - Denton 2801 S Mayhill Rd, Denton Q9967 $209 [source] 3 years ago
Baylor Scott & White Emergency Hospital - Aubrey 26791 Us Highway 380 E, Aubrey Q9967 $209 [source] 3 years ago
Baylor Scott & White Medical Center - Lake Pointe 6800 Scenic Dr, Rowlett Q9967 $209 [source] 3 years ago
Baylor Scott & White Medical Center - Waxahachie 2400 N Interstate 35E, Waxahachie Q9967 $209 [source] 3 years ago
Paris Regional Medical Center 865 Deshong Drive, Paris Q9967 $244 [source] 3 years ago
Doctors Hospital Of Laredo 10700 Mcpherson Road, Laredo Q9967 $320 [source] 3 years ago
Parkview Regional Hospital 600 South Bonham Street, Mexia Q9967 $364 [source] 3 years ago
Woman's Hospital Of Texas 7600 Fannin, Houston Q9967 $370 [source] 3 years ago
Fort Duncan Regional Medical Center 3333 N. Foster Maldonado Blvd., Eagle Pass Q9967 $388 [source] 3 years ago
Ennis Regional Medical Center 2201 West Lampasas, Waxahachie Q9967 $397 [source] 3 years ago
Northwest Texas Healthcare System 1501 S. Coulter, Amarillo Q9967 $410 [source] 3 years ago
St. David's Healthcare , Round Rock Q9967 $464 [source] 3 years ago
Rio Grande Regional Hospital 101 East Ridge Road, Mcallen Q9967 $589 [source] 3 years ago
Medical City North Hills 4401 Booth Calloway Rd, North Richland Hills Q9967 $660 [source] 3 years ago
Palestine Regional Medical Center 2900 South Loop 256, Palestine Q9967 $1,008 [source] 3 years ago
Corpus Christi Medical Center 7101 South Padre Island Dr, Corpus Christi Q9967 $1,064 [source] 3 years ago
Hca Houston Healthcare 3737 Buffalo Speedway Suite 140, Houston Q9967 $1,272 [source] 3 years ago
Medical City Denton 3535 S Interstate 35, Corinth Q9967 $1,538 [source] 3 years ago
Medical City Weatherford 713 E Anderson St, Weatherford Q9967 $1,601 [source] 3 years ago
Medical City Fort Worth 900 8Th Ave, Fort Worth Q9967 $1,612 [source] 3 years ago
Medical City Dallas 13155 Noel Rd. Suite 200, Dallas Q9967 $1,773 [source] 3 years ago
Valley Regional Medical Center 100-A Alton Gloor Blvd, Brownsville Q9967 $2,891 [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.