Gastrografin oral contrast solution at Southeast Texas - Jasper Memorial

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.

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Provider: anthropic
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Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

diatrizoate meglumine & sodium (37% iodine) (GASTROGRAFIN) solution 50 mL

Jasper, TX

See all hospitals reporting HCPCS Q9963 →

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Pricing by billing methodology

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How this price compares nationally

Southeast Texas - Jasper Memorial’s median price of $145 is 4431% above the median hospital's median price ($3), higher than 92% 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 Southeast Texas - Jasper Memorial

Negotiated rates from the hospital’s own file: 11 payers, 23 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	UnitedHealthcare all payer fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
2	UnitedHealthcare hix fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
3	Humana choicecare fee schedule · outpatient	$0	$0	—	—	—	$0 – $0
4	Bcbs Tx blue advantage hmo fee schedule · outpatient	$1	$1	—	—	—	$1 – $1
5	Bcbs Tx heb fee schedule · outpatient	$1	$1	—	—	—	$1 – $1
6	Bcbs Tx hmo fee schedule · outpatient	$1	$1	—	—	—	$1 – $1
7	Bcbs Tx ppo fee schedule · outpatient	$1	$1	—	—	—	$1 – $1
8	Bcbs Tx traditional fee schedule · outpatient	$1	$1	—	—	—	$1 – $1
9	UnitedHealthcare chip km percent of total billed charges · outpatientfrom % of charges	$68	$68	—	—	—	$68 – $68
10	UnitedHealthcare star kid km percent of total billed charges · outpatientfrom % of charges	$68	$68	—	—	—	$68 – $68
11	UnitedHealthcare star km percent of total billed charges · outpatientfrom % of charges	$68	$68	—	—	—	$68 – $68
12	UnitedHealthcare star plus km percent of total billed charges · outpatientfrom % of charges	$68	$68	—	—	—	$68 – $68
13	Aetna mm percent of total billed charges · outpatientfrom % of charges	$116	$116	—	—	—	$116 – $116
14	Molina chip km percent of total billed charges · outpatientfrom % of charges	$145	$145	—	—	—	$145 – $145
15	Molina star km percent of total billed charges · outpatientfrom % of charges	$145	$145	—	—	—	$145 – $145
16	Molina star plus km percent of total billed charges · outpatientfrom % of charges	$145	$145	—	—	—	$145 – $145
17	Cigna new business percent of total billed charges · outpatientfrom % of charges	$188	$188	—	—	—	$188 – $188
18	Healthcare Highways ppo percent of total billed charges · outpatientfrom % of charges	$217	$217	—	—	—	$217 – $217
19	Devoted mm percent of total billed charges · outpatientfrom % of charges	$242	$242	—	—	—	$242 – $242
20	Cigna ppo percent of total billed charges · outpatientfrom % of charges	$290	$290	—	—	—	$290 – $290
21	First Health ppo percent of total billed charges · outpatientfrom % of charges	$314	$314	—	—	—	$314 – $314
22	MultiPlan ppo percent of total billed charges · outpatientfrom % of charges	$314	$314	—	—	—	$314 – $314
23	Phcs ppo percent of total billed charges · outpatientfrom % of charges	$314	$314	—	—	—	$314 – $314

Last updated: Jan 13, 2026

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