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High Osmolar Contrast Material, Iodine 350-399 mg/mL

Montana rates for HCPCS Q9963 · Gastrografin, MD Gastroview

High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml

Rates data updated October 2026.

How much does High Osmolar Contrast Material, Iodine 350-399 mg/mL cost?

$2.51per dose

One 10 mL dose, at the doctor's office rate. In Montana, October 2026.

Negotiated ratewhat insurers pay per mL of the drug
$0.25 / mL
Average doseacross Medicare claims, discarded units included
× 10 mL
One dosedrug only; giving it and the visit are billed separately
$2.51

Work out the cost of a dose

This drug is priced per mL. Enter the amount given to see what insurers have agreed to pay for it. Prefilled with the average administration in Medicare claims, discarded units included.

mL
In a doctor's office or clinic
$2.51
At a hospital outpatient department
$2.57

The same drug, in the same amount, costs 2% more at a hospital than at a doctor's office.

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

Where the price changes

Given atPer mLPer 10 mL dose
Doctor's office or clinic$0.25$2.51
Hospital outpatient department$0.26$2.57

How much rates vary

Facilitymedian $0 · 10th to 90th $0 to $0Professionalmedian $0 · 10th to 90th $0 to $0
$0.2$0.5$1facility $0professional $0

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$0.21
Median
$0.23
Typical High
$0.40
Cigna
Setting
Facility
Modifier
None
Typical Low
$0.25
Median
$0.25
Typical High
$0.55
Cigna
Setting
Professional
Modifier
None
Typical Low
$0.21
Median
$0.25
Typical High
$0.25
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$0.21
Median
$0.26
Typical High
$0.42
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$0.26
Median
$0.33
Typical High
$0.42
Providence
Setting
Facility
Modifier
None
Typical Low
$0.25
Median
$0.25
Typical High
$0.55
Providence
Setting
Professional
Modifier
None
Typical Low
$0.24
Median
$0.25
Typical High
$0.28
United
Setting
Professional
Modifier
None
Typical Low
$0.22
Median
$0.22
Typical High
$0.22

Where Montana sits

The same service costs 2.7 times more in Wyoming than in New Hampshire. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 5th of 51

$0.25

WY $0.56NH $0.21

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.