Gastrografin oral contrast solution at BSA Hospital

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

Amarillo, TX

See all hospitals reporting HCPCS Q9963 →

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Pricing by billing methodology

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How this price compares nationally

BSA Hospital’s median price of $128 is 3899% above the median hospital's median price ($3), higher than 91% of the 1,827 hospitals reporting HCPCS Q9963. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q9963 at BSA Hospital

Negotiated rates from the hospital’s own file: 9 payers, 21 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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#
1	Blue Cross Blue Shield bcbs medicaid [116504] facility · percent of total billed charges · bothfrom % of charges	$20	$20	$3	16%	—	$17 – $24
2	Blue Cross Blue Shield bcbs tx medicaid chip [116506] facility · percent of total billed charges · bothfrom % of charges	$20	$20	$3	16%	—	$17 – $24
3	Aetna aetna better health [351001] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
4	Cigna cigna healthspring medicaid replacement [394500] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
5	Healthcare Highways hch 90 degree benefits [221013] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
6	Healthcare Highways hch broken arrow [221012] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
7	Healthcare Highways hch john soules foods [221011] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
8	UnitedHealthcare uhc comm mcaid health pla [225001] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
9	UnitedHealthcare uhc medicaid community plan [375501] facility · percent of total billed charges · bothfrom % of charges	$85	$85	$14	16%	—	$71 – $99
10	UnitedHealthcare united healthcare core exclusive [206022] facility · percent of total billed charges · bothfrom % of charges	$93	$93	$15	16%	30	$78 – $109
11	UnitedHealthcare uhc surest bind [206032] facility · percent of total billed charges · bothfrom % of charges	$134	$134	$22	16%	240	$112 – $156
12	UnitedHealthcare united healthcare student svc [206012] facility · percent of total billed charges · bothfrom % of charges	$134	$134	$22	16%	—	$112 – $156
13	Aetna aetna client specific [101506] facility · percent of total billed charges · bothfrom % of charges	$142	$142	$23	16%	—	$119 – $165
14	Medica medica harmony [291000] facility · percent of total billed charges · bothfrom % of charges	$153	$153	$25	16%	—	$128 – $178
15	Phcs freedom life [178009] facility · percent of total billed charges · bothfrom % of charges	$153	$153	$25	16%	—	$128 – $178
16	Phcs phcs multiplan [178000] facility · percent of total billed charges · bothfrom % of charges	$153	$153	$25	16%	—	$128 – $178
17	UnitedHealthcare united healthcare shared svcs [206010] facility · percent of total billed charges · bothfrom % of charges	$159	$159	$26	16%	—	$133 – $184
18	Aetna american continental [101507] facility · percent of total billed charges · bothfrom % of charges	$164	$164	$27	16%	—	$137 – $190
19	Aetna meritain aetna [368500] facility · percent of total billed charges · bothfrom % of charges	$164	$164	$27	16%	—	$137 – $190
20	Kaiser kaiser permanete oakland ca [156000] facility · percent of total billed charges · bothfrom % of charges	$186	$186	$30	16%	—	$155 – $216
21	MultiPlan international benefits administrators [168005] facility · percent of total billed charges · bothfrom % of charges	$186	$186	$30	16%	—	$155 – $216

Last updated: Feb 12, 2026

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