| Item Number | Description | Schedule Fee |
|---|---|---|
| 18370 | Botulinum Toxin Type A Purified Neurotoxin Complex (Botox), injection of, for the treatment of unilateral blepharospasm in a patient who is at least 12 years of age, including all such injections on any one day (Anaes.) |
$52.55 |
| Total: | $52.55 | |