Gastrografin oral contrast solution

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

DIATRIZOATE MEGLUMINE-DIATRIZOATE SODIUM 66 %-10 % ORAL SOLUTION

Payers reporting HCPCS Q9963

Payer pricing summary

Low

Average

$145

Median

$69

High

$2.3k

Payer rate distribution

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#
1	Anthem fee schedule · outpatient · +22 other terms	112	$0	$6	$53	876%	173–317	$0 – $895
2	Blue Cross Blue Shield fee schedule · outpatient · +28 other terms	255	$1	$9	$51	570%	139–211	$0 – $1.1k
3	Kaiser fee schedule · both · +18 other terms	46	$0	$19	$110	580%	24	$0 – $670
4	UnitedHealthcare fee schedule · outpatient · +28 other terms	478	$0	$19	$90	467%	10–100	$0 – $1.3k
5	Cigna fee schedule · outpatient · +23 other terms	353	$0	$20	$84	429%	8–80	$0 – $1.1k
6	Medica fee schedule · outpatient · +16 other terms	38	$3	$18	$43	240%	8–80	$0 – $354
7	Molina fee schedule · outpatient · +22 other terms	54	$1	$6	$22	392%	2–20	$0 – $174
8	Bcbs Wy other · both · +1 other terms	1	$80	$80	—	—	1–10	$80 – $80
9	Aetna fee schedule · outpatient · +28 other terms	183	$1	$37	$124	332%	—	$0 – $1.0k
10	Humana fee schedule · outpatient · +22 other terms	172	$0	$18	$92	522%	—	$0 – $1.1k
11	MultiPlan fee schedule · outpatient · +17 other terms	88	$47	$155	$247	160%	—	$0 – $1.4k
12	Caresource fee schedule · outpatient · +13 other terms	51	$0	$163	$209	128%	—	$0 – $435
13	Highmark facility · fee schedule · outpatient · +11 other terms	39	$0	$1	$0	62%	—	$0 – $2
14	First Health fee schedule · outpatient · +15 other terms	31	$136	$145	$224	154%	—	$1 – $906
15	Medcost percent of total billed charges · bothfrom % of charges · +6 other terms	29	$6	$340	$174	51%	—	$0 – $464
16	Healthcare Highways percent of total billed charges · outpatientfrom % of charges · +2 other terms	28	$146	$299	$342	114%	—	$14 – $1.8k
17	Baylor Scott White Health Plan facility · percent of total billed charges · inpatientfrom % of charges · +1 other terms	26	$54	$48	$30	63%	—	$15 – $93
18	Phcs fee schedule · inpatient · +11 other terms	21	$13	$63	$227	363%	—	$6 – $1.3k
19	Regence professional · fee schedule · outpatient · +14 other terms	21	$0	$0	$0	5%	—	$0 – $0
20	Beechstreet percent of total billed charges · outpatientfrom % of charges · +3 other terms	20	$160	$166	$118	71%	—	$2 – $719
21	Bcbs La fee schedule · outpatient · +4 other terms	19	$0	$0	$0	4%	—	$0 – $0
22	Optum professional · fee schedule · outpatient · +15 other terms	19	$10	$8	$4	53%	—	$0 – $10
23	Oscar facility · fee schedule · outpatient · +11 other terms	19	$0	$0	$0	7%	—	$0 – $0
24	Healthpartners fee schedule · outpatient · +10 other terms	18	$0	$0	$0	4%	—	$0 – $0
25	Tricare facility · fee schedule · outpatient · +10 other terms	16	$220	$140	$140	100%	—	$1 – $368

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