| Item Number | Description | Schedule Fee |
|---|---|---|
| 15916 | Megavoltage re‑planning—level 3.2 Additional dosimetry plan for re‑planning of complex 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 15914 has been prepared; and (b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements Applicable once per course of treatment |
$3,048.40 |
| Total: | $3,048.40 | |