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
Wisconsin
Hospital Address Code Price Last Updated
Aspirus Medford Hospital 135 S Gibson St, Medford Q9967 $2 [source] 3 years ago
Aspirus Langlade Hospital 110 E 5Th Ave, Antigo Q9967 $2 [source] 3 years ago
Adventhealth Durand 1220 3Rd Ave W, Durand Q9967 $2 [source] 3 years ago
Aspirus Stevens Point Hospital 5409 Vern Holmes Dr, Q9967 $60 [source] 3 years ago
Aspirus Wausau Hospital 333 Pine Ridge Blvd, Wausau Q9967 $60 [source] 3 years ago
Prairie Ridge Health 1515 Park Ave, Columbus Q9967 $89 [source] 3 years ago
Aspirus Riverview Hospital 410 Dewey St, Wisconsin Rapids Q9967 $128 [source] 3 years ago
Aspirus Divine Savior Hospital 2817 New Pinery Rd, Portage Q9967 $191 [source] 3 years ago
Watertown Regional Medical Center 125 Hospital Drive, Watertown Q9967 $548 [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.