| Item Number | Description | Schedule Fee |
|---|---|---|
| 15912 | Megavoltage re‑planning—level 3.1 Additional dosimetry plan for re‑planning of standard intensity modulated radiation therapy (IMRT) treatment, if: (a) an initial treatment plan at a level that is equivalent to or higher than that described in item 15910 has been prepared; and (b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements Applicable once per course of treatment |
$2,121.05 |
| Total: | $2,121.05 | |