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Tarifas de Radiofármacos - 2008

HCPC
Code

 Description Fee Comments
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 $ 121.70  
A9501 Technetium TC-99m Teboroxime, diagnostic, per study dose Invoice add 1/1/2008
A9502 Technetium TC-99m Tetrofosmin, diagnostic, per study dose up to 40 millicuries $ 119.70  
A9503 Technetium TC-99m medronate, diagnostic, per study dose up to 30 millicuries $ 22.67  
A9504 Technetium TC-99m apcitide, diagnostic, per study dose up to 20 millicuries $ 475.00  
A9505 Thallium Ti-201 thallous chloride, diagnostic per millicuries $ 33.23  
A9507 Indium In-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries $ 2,949.41  
A9508 Iodine I-31 iobenguane sulfate, diagnostic per 0.5 millicuries $ 842.60  
A9509 Iodine I-123 Sodium Iodide, diagnostic, per millicurie Invoice add 1/1/2008
A9510 Technetium TC-99m disofenin, diagnostic, per study dose up to 15 millicuries $ 43.54  
A9512 Technetium TC-99m pertechnetate, diagnostic, per millicuries $ 0.62  
A9516 Iodine I-123 sodium iodide capsule(s), diagnostic per 100 microcuries up to 999 microcuries $ 103.47  
A9517 Iodine I-131 sodium iodide capsule(s), therapeutic per millicuries $ 15.77  
A9521 Technetium TC-99m exametazine, diagnostic, per study dose, up to 25 millicuries $ 567.61  
A9524 Iodine I-131 iodinated serum albumin, diagnostic, per 5 microcuries Invoice  
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 $ 12.00  
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  
A9535 Injection, methylene blue, 1ml $ 0.31  
A9536 Technetium TC-99m depreotide, diagnostic, per study dose up to 35 millicuries $ 736.00  
A9537 Technetium TC-99m mebrofenin, diagnostic, per study dose up to 15 millicuries $ 63.06  
A9538 Technetium TC-99m pyrophosphate, diagnostic, per study dose up to 25 millicuries $ 32.84  
A9539 Technetium TC-99m pentetate, diagnostic, per study dose up to 25 millicuries $ 16.25  
A9540 Technetium TC-99m macroaggregated albumin, diagnostic, per study dose up to 10 millicuries $ 21.69  
A9541 Technetium TC-99m sulfur colloid, diagnostic, per study dose up to 20 millicuries $ 53.20  
A9542 Indium In-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries Invoice  
A9543 Yttrium Y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries Invoice  
A9544 Iodine I –131 tositumomab, diagnostic, per study dose $ 132.10  
A9545 Iodine I –131 tositumomab, therapeutic, per treatment dose Invoice  
A9546 Cobalt Co-57/58 cyanocobalamin, diagnostic, per study dose, up to 1 microcuries Invoice  
A9547 Indium In- 111 oxyquinoline, diagnostic, per 0.5 millicuries $ 280.35  
A9548 Indium In- 111 pentetate, diagnostic, per 0.5 millicuries $ 274.21  
A9549   Invoice  
A9550 Technetium TC-99m sodium gluceptate, diagnostic, per study dose up to 25 millicuries Invoice  
A9551 Technetium TC-99m succimer diagnostic, per study dose up to 10 millicuries $ 126.63  
A9552 Fluorodeoxyglucose F-18 FDG, diagnostic per study dose, up to 45 millicuries $ 490.00  
A9553 Chromium Cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries $ 403.22  
A9554 Iodine I-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries Invoice  
A9555 Rubidium Rb-82, diagnostic, per study dose, up to 60 millicuries Invoice  
A9556 Gallium Ga-67 citrate, diagnostic, per millicuries $ 31.53  
A9557 Technetium TC-99m bicisate, diagnostic, per study dose up to 25 millicuries $ 299.00  
A9558 Xenon Xe- 133 gas, diagnostic per 10 millicuries $ 38.96  
A9559 Cobalt Co-57 cyanocobalamin, oral, diagnostic, per study dose, up to 1 microcuries Invoice  
A9560 Technetium TC-99m labeled red blood cells, diagnostic, per study dose up to 30 millicuries $ 114.00  
A9561 Technetium TC-99m oxidranate, diagnostic, per study dose up to 30 millicuries $ 50.16  
A9562 Technetium TC-99m mertiatide, diagnostic, per study dose up to 15 millicuries $ 588.24  
A9563 Sodium phosphate P-32, therapeutic, per millicurie Invoice  
A9564 Chromic phosphate P-32 suspension, therapeutic, per millicurie Invoice  
A9565 Indium IN-111 Pentetreotide, Diagnostic, per millicurie $ - deleted 12/31/2007
A9566 Technetium TC-99m fanolesomab, diagnostic, per study dose up to 25 millicuries Invoice  
A9567 Technetium TC-99m pentetate diagnostic, aerosol per study dose up to 75 millicuries $ 299.00  
A9568 Technetium TC-99m arcitumomab, diagnostic, per study dose up to 45 millicuries Invoice  
A9569 Technetium TC-99m Exametazine labeled autologous WBC’s diagnostic, per study dose, Invoice add 1/1/2008
A9570 Indium In- 111 labeled autologous white blood cells diagnostic, per study Invoice add 1/1/2008
A9571 Indium In- 111 labeled autologous platelets diagnostic, per study Invoice add 1/1/2008
A9572 Indium In- 111 pentetreotide diagnostic, per study up to 6 millicuries Invoice add 1/1/2008
A9600 Strontium Sr-89 chloride, therapeutic, per millicurie Invoice  
A9605 Samarium Sm-153 lexidronamm, therapeutic, per 50 millicuries Invoice  
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