| Code | Description | States | Median rate |
|---|---|---|---|
| A9274 | External ambulatory insulin delivery system, disposable, each, includes all supplies and accessories | 15 | $35.30 |
| A9276 | Sensor; invasive (e.g., subcutaneous), disposable, for use with non-durable medical equipment interstitial continuous glucose monitoring system, one unit = 1 day supply | 12 | $12.95 |
| A9277 | Transmitter; external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 12 | $637.09 |
| A9278 | Receiver (monitor); external, for use with non-durable medical equipment interstitial continuous glucose monitoring system | 10 | $559.20 |
| A9500 | Technetium tc-99m sestamibi, diagnostic, per study dose | 28 | $102.68 |
| A9502 | Technetium tc-99m tetrofosmin, diagnostic, per study dose | 27 | $97.21 |
| A9503 | Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries | 25 | $17.07 |
| A9505 | Thallium tl-201 thallous chloride, diagnostic, per millicurie | 26 | $32.66 |
| A9507 | Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries | 14 | $1,557.26 |
| A9508 | Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie | 13 | $479.69 |
| A9510 | Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries | 15 | $59.06 |
| A9512 | Technetium tc-99m pertechnetate, diagnostic, per millicurie | 15 | $1.96 |
| A9513 | Lutetium lu 177, dotatate, therapeutic, 1 millicurie | 21 | $320.36 |
| A9515 | Choline c-11, diagnostic, per study dose up to 20 millicuries | 12 | $5,027.40 |
| A9516 | Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries | 15 | $70.86 |
| A9517 | Iodine i-131 sodium iodide capsule(s), therapeutic, per millicurie | 20 | $31.71 |
| A9520 | Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries | 11 | $462.28 |
| A9521 | Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries | 16 | $789.51 |
| A9524 | Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries | 13 | $65.45 |
| A9526 | Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries | 12 | $629.50 |
| A9530 | Iodine i-131 sodium iodide solution, therapeutic, per millicurie | 11 | $18.69 |
| A9537 | Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries | 19 | $48.12 |
| A9538 | Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries | 17 | $44.51 |
| A9539 | Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries | 12 | $26.82 |
| A9540 | Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries | 13 | $29.55 |
| A9541 | Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries | 17 | $52.88 |
| A9542 | Indium in-111 ibritumomab tiuxetan, diagnostic, per study dose, up to 5 millicuries | 12 | $2,314.08 |
| A9543 | Yttrium y-90 ibritumomab tiuxetan, therapeutic, per treatment dose, up to 40 millicuries | 16 | $56,824.55 |
| A9547 | Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie | 18 | $748.31 |
| A9548 | Indium in-111 pentetate, diagnostic, per 0.5 millicurie | 17 | $671.06 |
| A9551 | Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries | 16 | $585.75 |
| A9552 | Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries | 20 | $317.61 |
| A9553 | Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries | 13 | $455.42 |
| A9554 | Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries | 15 | $53.13 |
| A9556 | Gallium ga-67 citrate, diagnostic, per millicurie | 12 | $90.06 |
| A9557 | Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries | 15 | $666.58 |
| A9558 | Xenon xe-133 gas, diagnostic, per 10 millicuries | 16 | $247.08 |
| A9560 | Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries | 11 | $68.00 |
| A9561 | Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries | 11 | $36.04 |
| A9562 | Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries | 13 | $350.78 |
| A9563 | Sodium phosphate p-32, therapeutic, per millicurie | 12 | $250.42 |
| A9564 | Chromic phosphate p-32 suspension, therapeutic, per millicurie | 11 | $331.13 |
| A9568 | Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries | 10 | $1,151.02 |
| A9569 | Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose | 13 | $961.22 |
| A9570 | Indium in-111 labeled autologous white blood cells, diagnostic, per study dose | 13 | $1,103.19 |
| A9572 | Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries | 15 | $2,245.69 |
| A9573 | Injection, gadopiclenol, 1 ml | 14 | $3.30 |
| A9574 | Injection, ferumoxytol, 1 mg | 12 | $0.41 |
| A9575 | Injection, gadoterate meglumine, 0.1 ml | 20 | $0.09 |
| A9576 | Injection, gadoteridol, (prohance multipack), per ml | 20 | $1.38 |
| A9577 | Injection, gadobenate dimeglumine (multihance), per ml | 21 | $1.79 |
| A9578 | Injection, gadobenate dimeglumine (multihance multipack), per ml | 19 | $1.71 |
| A9579 | Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml | 23 | $1.44 |
| A9581 | Injection, gadoxetate disodium, 1 ml | 24 | $14.75 |
| A9582 | Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries | 15 | $2,741.09 |
| A9584 | Iodine 1-123 ioflupane, diagnostic, per study dose, up to 5 millicuries | 15 | $1,929.28 |
| A9585 | Injection, gadobutrol, 0.1 ml | 23 | $0.28 |
| A9586 | Florbetapir f18, diagnostic, per study dose, up to 10 millicuries | 17 | $2,783.84 |
| A9587 | Gallium ga-68, dotatate, diagnostic, 0.1 millicurie | 17 | $60.21 |
| A9588 | Fluciclovine f-18, diagnostic, 1 millicurie | 16 | $480.00 |
| A9589 | Instillation, hexaminolevulinate hydrochloride, 100 mg | 18 | $1,424.77 |
| A9590 | Iodine i-131, iobenguane, 1 millicurie | 13 | $320.26 |
| A9591 | Fluoroestradiol f 18, diagnostic, 1 millicurie | 15 | $460.42 |
| A9592 | Copper cu-64, dotatate, diagnostic, 1 millicurie | 18 | $905.15 |
| A9595 | Piflufolastat f-18, diagnostic, 1 millicurie | 22 | $566.14 |
| A9596 | Gallium ga-68 gozetotide, diagnostic, (illuccix), 1 millicurie | 21 | $972.38 |
| A9600 | Strontium sr-89 chloride, therapeutic, per millicurie | 19 | $3,690.00 |
| A9602 | Fluorodopa f-18, diagnostic, per millicurie | 12 | $534.36 |
| A9604 | Samarium sm-153 lexidronam, therapeutic, per treatment dose, up to 150 millicuries | 15 | $11,843.68 |
| A9606 | Radium ra-223 dichloride, therapeutic, per microcurie | 25 | $165.18 |
| A9607 | Lutetium lu 177 vipivotide tetraxetan, therapeutic, 1 millicurie | 22 | $255.84 |
| A9608 | Flotufolastat f 18, diagnostic, 1 millicurie | 16 | $677.19 |
| A9611 | Flurpiridaz f 18, diagnostic, 1 millicurie | 13 | $507.50 |
| A9615 | Injection, pegulicianine, 1 mg | 10 | $37.51 |
| A9616 | Gallium ga-68 gozetotide (gozellix), diagnostic, 1 millicurie | 10 | $1,108.87 |
| A9800 | Gallium ga-68 gozetotide, diagnostic, (locametz), 1 millicurie | 17 | $709.56 |
Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.