Gastrografin oral contrast solution at Proctor Community 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

GASTROGRAFIN 66 %-10 % ORAL SOLUTION

Peoria, IL

See all hospitals reporting HCPCS Q9963 →

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Pricing by billing methodology

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How this price compares nationally

Proctor Community Hospital’s median price of $74 is 2242% above the median hospital's median price ($3), higher than 81% of the 1,837 hospitals reporting HCPCS Q9963. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS Q9963 at Proctor Community Hospital

Negotiated rates from the hospital’s own file: 7 payers, 18 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	Aetna Better Health medicare-medicaid (d-snp) fee schedule · inpatient	$0	$0	—	—	—	$0 – $0
2	Aetna Better Health medicare-medicaid (d-snp) fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
3	UnitedHealthcare ppo other · outpatient	$43	$43	—	—	3–30	$43 – $43
4	Aetna Better Health managed medicaid percent of total billed charges · inpatientfrom % of charges	$44	$69	$40	59%	—	$37 – $125
5	Aetna Better Health managed medicaid percent of total billed charges · outpatientfrom % of charges	$44	$69	$40	59%	—	$37 – $125
6	Molina managed medicaid percent of total billed charges · inpatientfrom % of charges	$52	$82	$48	59%	—	$45 – $151
7	Molina managed medicaid percent of total billed charges · outpatientfrom % of charges	$52	$82	$48	59%	—	$45 – $151
8	Molina medicare-medicaid (mmai/dual) percent of total billed charges · inpatientfrom % of charges	$52	$82	$48	59%	—	$45 – $151
9	Molina medicare-medicaid (mmai/dual) percent of total billed charges · outpatientfrom % of charges	$52	$82	$48	59%	—	$45 – $151
10	Blue Cross Blue Shield blue choice percent of total billed charges · outpatientfrom % of charges	$68	$107	$63	59%	3–30	$58 – $196
11	Blue Cross Blue Shield blue choice options percent of total billed charges · outpatientfrom % of charges	$68	$107	$63	59%	—	$58 – $196
12	Blue Cross Blue Shield ppo percent of total billed charges · outpatientfrom % of charges	$69	$109	$64	59%	25	$59 – $198
13	Blue Cross Blue Shield hmo percent of total billed charges · outpatientfrom % of charges	$84	$132	$78	59%	—	$72 – $242
14	Aetna commercial ppo percent of total billed charges · outpatientfrom % of charges	$85	$135	$79	59%	3–30	$73 – $246
15	Aetna medicare advantage percent of total billed charges · outpatientfrom % of charges	$87	$137	$80	59%	—	$74 – $251
16	MultiPlan ppo percent of total billed charges · inpatientfrom % of charges	$87	$137	$80	59%	—	$74 – $251
17	MultiPlan ppo percent of total billed charges · outpatientfrom % of charges	$87	$137	$80	59%	—	$74 – $251
18	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$117	$184	$108	59%	—	$100 – $336

Last updated: Apr 15, 2026

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