Allowance for Radiopharmaceuticals
A4642 “Indium In-111 satumomab pendetide, diagnostic, per study dose up to 6 millicuries” INVOICE
A9500 “Technetium TC-99m sestamibi, diagnostic, per study dose up to 40 millicuries” $117.85
A9501 “Technetium TC-99m Teboroxime, diagnostic, per study dose ” INVOICE
A9502 “Technetium TC-99m Tetrofosmin, diagnostic, per study dose up to 40 millicuries” $111.65
A9503 “Technetium TC-99m medronate, diagnostic, per study dose up to 30 millicuries” $19.77
A9504 “Technetium TC-99m apcitide, diagnostic, per study dose up to 20 millicuries” INVOICE
A9505 “Thallium Ti-201 thallous chloride, diagnostic per millicuries” $33.12
A9507 “Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries” $3,456.08
A9508 “Iodine I-31 iobenguane sulfate, diagnostic per 0.5 millicuries” INVOICE
A9509 “Iodine I-123 Sodium Iodide, diagnostic, per millicurie” INVOICE
A9510 “Technetium TC-99m disofenin, diagnostic, per study dose up to 15 millicuries” $44.16
A9512 “Technetium TC-99m pertechnetate, diagnostic, per millicuries” INVOICE
A9516 “Iodine I-123 sodium iodide capsule(s), diagnostic per 100 microcuries up to 999 microcuries” INVOICE
A9517 “Iodine I-131 sodium iodide capsule(s), therapeutic per millicuries” INVOICE
A9521 “Technetium TC-99m exametazine, diagnostic, per study dose, up to 25 millicuries” $686.03
A9524 “Iodine I-131 iodinated serum albumin, diagnostic, per 5 microcuries” $59.80
A9526 “Nitrogen N-13 ammonia, diagnostic, per study dose, up to 40 millicuries” INVOICE
A9527 “Iodine I-125, sodium iodide solution, therapeutic, per millicuries” INVOICE
A9528 “Iodine I-131 sodium iodide capsules(s), diagnostic, per millicuries” INVOICE
A9529 “Iodine I-131 sodium iodide solution, diagnostic, per millicuries” INVOICE
A9530 “Iodine I-131 sodium iodide solution, therapeutic, per millicuries” INVOICE
A9531 “Iodine I-131 sodium iodide diagnostic per microcuries, up to 100 microcuries” INVOICE
A9532 “Iodine I-125 serum albumin, diagnostic per 5 microcuries” INVOICE
