|
C1716 |
 |
Brachytherapy source, non-stranded, gold-198, per source
| short | Brachytx, non-str, gold-198 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 4.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
C1717 |
|
Brachytherapy source, non-stranded, high dose rate iridium-192, per source
| short | Brachytx, non-str,hdr ir-192 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 10.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|
|
C1719 |
|
Brachytherapy source, non-stranded, non-high dose rate iridium-192, per source
| short | Brachytx, ns, non-hdrir-192 |
| MUE | | Location | Value | Ajudication Indicator | Rationale |
|---|
| PRA | 99.0 | 3 Date of Service Edit: Clinical | Clinical: Data | | OPH | 99.0 | 3 Date of Service Edit: Clinical | Clinical: Data |
|
|
|