| Item Number | Description | Schedule Fee |
|---|---|---|
| 15922 | Megavoltage re‑planning—level 4 Additional dosimetry plan for re‑planning of intracranial stereotactic radiation therapy (SRT) or stereotactic body radiation therapy (SBRT) treatment, if: (a) an initial treatment plan at a level that is equivalent to or higher than that described in item 15918 or 15920 has been prepared; and (b) treatment adjustments to the initial plan are inadequate to satisfy treatment protocol requirements Applicable once per course of treatment |
$3,418.15 |
| Total: | $3,418.15 | |