ESTIMATED USAGE RADIOPHARMACEUTICALS-VA FRESNO.xlsx
XLSX spreadsheet 16 KB Posted
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Sheet1
| CPT | Item | 1-hr Delivery (Y/N) | Est # UD | Est # mCi | Units | Contract Price | UOM | Cost | Contract Price | Cost |
| A4641 | C-14 Carbon-14 urea kit (including H Pylori Breath Test Analysis) | 2 | kit | $0.00 | ||||||
| A9552 | F-18 FDG Fludeoxyglucose UD | 0 | UD | $0.00 | ||||||
| A9556 | Ga-67 (Gallium Citrate) (~0.080 mCi per UD) | 2 | 0.16 | mCi | $0.00 | |||||
| A9556 | Ga-67 (Gallium Citrate) (~6 mCi per UD) | 2 | 12 | mCi | $0.00 | |||||
| A9556 | Ga-67 (Gallium Citrate) (~9 mCi per UD) | 2 | 18 | mCi | $0.00 | |||||
| A9516 | I-123 (Sodium Iodide I-123 Capsule) (0.2 mCi capsule) | 10 | UD | $0.00 | ||||||
| A9516 | I-123 (Sodium Iodide I-123 Capsules) (4 mCi capsule) | 2 | UD | $0.00 | ||||||
| A9516 | I-123 Iobenguane Sulfate; I-123 MIBG (Adreview) UD | 0 | UD | $0.00 |
| I-131 (Sodium Iodide Compounded Capsules) per first 6 mCi each order | 5 | UD | $0.00 | ||
| A9517 | I-131 (Sodium Iodide Compounded Capsules) per ~1-2 mCi capsule | 0 | $0.00 | ||
| A9517 | I-131 (Sodium Iodide Compounded Capsules) per ~10-15 mCi capsule | 2 | 30 | mCi | $0.00 |
| A9517 | I-131 (Sodium Iodide Compounded Capsules) per ~30 mCi capsule | 1 | 30 | mCi | $0.00 |
| A9517 | I-131 (Sodium Iodide Compounded Capsules) per ~100 mCi capsule | 2 | 200 | mCi | $0.00 |
| A9507 | In-111 Capromab Pendetide (Prostascint) UD | 0 | UD | $0.00 | |
| A9572 | In-111 Pentetreotide (Octreoscan®) UD | 4 | UD | $0.00 | |
| A9604 | Sm-153 Lexidronam (Quadramet®) ~100 mCi UD | 1 | UD | $0.00 | |
| A9600 | Sr-89 Strontium Chloride UD | 1 | UD | $0.00 | |
| A9557 | Tc99m Bicisate Dihydrochloride (Neurolite®) UD | 0 | UD | $0.00 | |
| A9510 | Tc99m Disofenin UD | 0 | UD | $0.00 | |
| A9539 | Tc99m DTPA (Pentetate) [15 mCi for injection] UD | 5 | UD | $0.00 | |
| A9567 | Tc99m DTPA ~45 mCi Pulmonary [for aerosol] UD | 30 | UD | $0.00 | |
| A9521 | Tc99m Ceretec (Exametazime aka HMPAO) UD {brain study} | 0 | UD | $0.00 | |
| A9561 | Tc99m HDP (Oxidronate) UD | 0 | UD | $0.00 | |
| A9540 | Tc99m MAA (Macroaggregated Albumin) UD | 30 | UD | $0.00 | |
| A9503 | Tc99m MDP (Medronate) UD | 200 | UD | $0.00 | |
| A9537 | Tc99m Mebrofenin (Choletec) UD | 45 | UD | $0.00 | |
| A9562 | Tc99m Mertiatide (MAG3) UD | 20 | UD | $0.00 | |
| A9512 | Tc99m NaTc04 UD (~25-35 mCi) | 40 | UD | $0.00 | |
| TC99m NaTc04-QC; syringe (~10 mCi per UD) | 2 | UD | $0.00 | ||
| TC99m NaTc04-QC; VIAL (~250 mCi per vial) | 4 | 1000 | mCi | $0.00 | |
| A9538 | Tc99m PYP (Pyrophosphate) UD | 0 | UD | $0.00 |
| A9500 | Tc99m Sestamibi-Generic UD | 1050 | UD | $0.00 |
| A9500 | Tc99m Sestamibi as Cardiolite UD | UD | $0.00 | |
| A9502 | Tc99m Tetrofosmin (Myoview) UD | UD | $0.00 |
| Lidocaine dilution for sulfur colloid intradermal injection | 8 | ea | $0.00 | |
| A9541 | Tc99m Sulfur Colloid Filtered UD (~0.5 mCi per UD) | 20 | UD | $0.00 |
| A9541 | Tc99m Sulfur Colloid UD (~1 mCi per UD) (oral) | 4 | UD | $0.00 |
| A9541 | Tc99m Sulfur Colloid UD (~10 mCi per UD) | 4 | UD | $0.00 |
| A9505 | Tl-201 (Thallous Chloride) UD (1 mCi per UD) | 2 | 2 | UD | $0.00 |
| A9505 | Tl-201 (Thallous Chloride) UD (4 mCi per UD) | 10 | 40 | UD | $0.00 |
| A9560 | Sn-PYP (Pyrophosphate) VIAL for Labeling Red Blood Cells (per vial) | 0 | ea | $0.00 |
| A9560 | UltraTag® VIAL for Labeling Red Blood Cells (per vial) | 15 | ea | $0.00 |
| A9570 | Labeled WBC (autologous leukocytes) In-111 Oxine (Oxyquinoline) UD | 5 | UD | $0.00 |
| A9570 | Labeled WBC (autologous leukocytes) In-111 Chloride (Tropolone) UD | 1 | UD | $0.00 |
| A9569 | Labeled WBC (autologous leukocytes) Tc99m Ceretec (Exametazime HMPAO) UD | 1 | UD | $0.00 |
| WBC blood-tag Kit | 7 | ea | $0.00 |
| Adenoscan (Adenosine) Single Use per # mg ordered | 0 | mg | $0.00 |
| Adenoscan (Adenosine) 20 mL VIAL | 0 | Vial | $0.00 |
| Adenoscan (Adenosine) 30 mL VIAL | 0 | Vial | $0.00 |
| Captopril 50 mg tablet | 0 | ea | $0.00 |
| Kinevac (Cholecystokinin - CCK) UD | 0 | ea | $0.00 |
| Kinevac (Cholecystokinin - CCK) VIAL | 0 | ea | $0.00 |
| Lexiscan™ (Regadenoson) UD | 0 | UD | $0.00 |
| 2.5 cc Lifetime Syringe Shield | 0 | $0.00 |
| 3 cc Lifetime Syringe Shield | 0 | $0.00 |
| 5 cc Lifetime Syringe Shield | 0 | $0.00 |
| 10 cc Lifetime Syringe Shield | 0 | $0.00 |
Total Total $0.00
Sheet2
Sheet3
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