| Code | Description | Old Price | New Price | Allowable |
| 64400 | Nerve Block/ Trigeminal Nerve | $149.00 | $81.83 | |
| 64402 | Nerve Block Facial Nerve | $130.00 | ||
| 64612 | CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV | $88.00 | $72.25 |
Customized Left Topbar
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| Code | Description | Old Price | New Price | Allowable |
| 64400 | Nerve Block/ Trigeminal Nerve | $149.00 | $81.83 | |
| 64402 | Nerve Block Facial Nerve | $130.00 | ||
| 64612 | CHEMODNRVTJ MUSC MUSC INNERVATED FACIAL NRV | $88.00 | $72.25 |