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Procedure price report · Other OR therapeutic nervous system procedures

Botulinum injection, 1-4 muscles, each extra arm or leg

CPT 64643the billing code this page is about

Add-on charge for injections into one to four muscles of each additional arm or leg treated in the same session, used for muscle spasticity or dystonia.

Hospitals typically charge $398 cash for this outpatient procedure — the median across 1,146 hospitals that filed a usable cash price; the average of the middle 60% is $425. Most fall between $152 and $869 (20th–80th percentile).

Hospitals
1,146
States
50
Filings dated
Dec 2023 – Sep 2026
Computed
September 25, 2026
Prices checked
through September 24, 2026

Median: half of hospitals filed less, half more — and it is a price some hospital actually filed. Average of the middle 60%: the mean of the prices between the 20th and 80th percentiles. We never publish the plain average, the lowest or the highest price: the extremes in hospital price files are chargemaster artefacts, not prices anyone pays.

What hospitals charge, from cheapest to most expensive

Cash price percentiles, outpatient, across 1,146 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$101$171$398$715$1,306

The most expensive tenth of hospitals charges at least 13× what the cheapest tenth charges ($101 vs $1,306).

How the prices are spread

$75 – $103: 64 hospitals$75$103 – $142: 89 hospitals$142 – $195: 131 hospitals$142$195 – $268: 93 hospitals$268 – $368: 107 hospitals$268$368 – $505: 133 hospitals$505 – $694: 162 hospitals$505$694 – $953: 118 hospitals$953 – $1,309: 79 hospitals$953$1,309 – $1,798: 56 hospitals$1,309median $398price bands are equal on a log scale
Hospitals per price band (1,032 of 1,146 — the bands cover the 5th to 95th percentile)
FromToHospitals
$75$10364
$103$14289
$142$195131
$195$26893
$268$368107
$368$505133
$505$694162
$694$953118
$953$1,30979
$1,309$1,79856

By state

The median cash price in each state, against the national median of $398.

Alaska: 8 hospitals filed a usable price — fewer than 10, so no figureAKMaine: 5 hospitals filed a usable price — fewer than 10, so no figureMEVermont: 5 hospitals filed a usable price — fewer than 10, so no figureVTNew Hampshire: 7 hospitals filed a usable price — fewer than 10, so no figureNHWashington: median $660 across 29 hospitalsWA$660Idaho: median $429 across 13 hospitalsID$429Montana: 7 hospitals filed a usable price — fewer than 10, so no figureMTNorth Dakota: median $451 across 11 hospitalsND$451Minnesota: median $522 across 47 hospitalsMN$522Illinois: median $488 across 47 hospitalsIL$488Wisconsin: median $339 across 57 hospitalsWI$339Michigan: median $128 across 53 hospitalsMI$128New York: median $304 across 34 hospitalsNY$304Massachusetts: median $279 across 28 hospitalsMA$279Oregon: median $171 across 17 hospitalsOR$171Nevada: 7 hospitals filed a usable price — fewer than 10, so no figureNVWyoming: 5 hospitals filed a usable price — fewer than 10, so no figureWYSouth Dakota: 7 hospitals filed a usable price — fewer than 10, so no figureSDIowa: median $227 across 24 hospitalsIA$227Indiana: median $261 across 38 hospitalsIN$261Ohio: median $452 across 61 hospitalsOH$452Pennsylvania: median $188 across 39 hospitalsPA$188New Jersey: median $4,668 across 27 hospitalsNJ$4,668Connecticut: median $375 across 10 hospitalsCT$375Rhode Island: 3 hospitals filed a usable price — fewer than 10, so no figureRICalifornia: median $839 across 76 hospitalsCA$839Utah: 3 hospitals filed a usable price — fewer than 10, so no figureUTColorado: median $450 across 19 hospitalsCO$450Nebraska: median $188 across 16 hospitalsNE$188Missouri: median $191 across 40 hospitalsMO$191Kentucky: median $500 across 23 hospitalsKY$500West Virginia: median $226 across 10 hospitalsWV$226Virginia: median $552 across 34 hospitalsVA$552Maryland: 7 hospitals filed a usable price — fewer than 10, so no figureMDDelaware: 1 hospital filed a usable price — fewer than 10, so no figureDEArizona: median $514 across 14 hospitalsAZ$514New Mexico: 4 hospitals filed a usable price — fewer than 10, so no figureNMKansas: median $156 across 11 hospitalsKS$156Arkansas: 8 hospitals filed a usable price — fewer than 10, so no figureARTennessee: median $152 across 19 hospitalsTN$152North Carolina: median $573 across 24 hospitalsNC$573South Carolina: median $627 across 27 hospitalsSC$627Oklahoma: median $116 across 17 hospitalsOK$116Louisiana: median $201 across 19 hospitalsLA$201Mississippi: median $156 across 17 hospitalsMS$156Alabama: 7 hospitals filed a usable price — fewer than 10, so no figureALGeorgia: median $1,011 across 42 hospitalsGA$1,011Hawaii: 5 hospitals filed a usable price — fewer than 10, so no figureHITexas: median $395 across 65 hospitalsTX$395Florida: median $634 across 49 hospitalsFL$634
Cash price by state, most expensive first. National median $398. A state needs at least 10 hospitals with a usable price to show a figure.
StateHospitalsMedianvs national20th–80th
New Jersey NJ27$4,668+1072%$1,023 – $5,368
Georgia GA42$1,011+154%$632 – $1,117
California CA76$839+111%$446 – $1,012
Washington WA29$660+66%$174 – $899
Florida FL49$634+59%$405 – $1,388
South Carolina SC27$627+57%$627 – $869
North Carolina NC24$573+44%$185 – $658
Virginia VA34$552+39%$177 – $746
Minnesota MN47$522+31%$332 – $648
Arizona AZ14$514+29%$156 – $514
Kentucky KY23$500+25%$156 – $825
Illinois IL47$488+23%$123 – $701
Ohio OH61$452+13%$276 – $1,798
North Dakota ND11$451+13%$48 – $1,141
Colorado CO19$450+13%$184 – $703
Idaho ID13$429+8%$319 – $1,886
Texas TX65$395−1%$105 – $530
Connecticut CT10$375−6%$352 – $556
Wisconsin WI57$339−15%$261 – $485
New York NY34$304−24%$107 – $852
Massachusetts MA28$279−30%$158 – $1,118
Indiana IN38$261−34%$170 – $497
Iowa IA24$227−43%$140 – $576
West Virginia WV10$226−43%$90 – $397
Louisiana LA19$201−49%$145 – $475
Missouri MO40$191−52%$79 – $541
Nebraska NE16$188−53%$107 – $367
Pennsylvania PA39$188−53%$45 – $673
Oregon OR17$171−57%$143 – $1,683
Kansas KS11$156−61%$88 – $397
Mississippi MS17$156−61%$154 – $240
Tennessee TN19$152−62%$103 – $299
Michigan MI53$128−68%$90 – $679
Oklahoma OK17$116−71%$116 – $356
Alaska AK8not enough hospitals filed a usable price
Arkansas AR8not enough hospitals filed a usable price
Alabama AL7not enough hospitals filed a usable price
Maryland MD7not enough hospitals filed a usable price
Montana MT7not enough hospitals filed a usable price
New Hampshire NH7not enough hospitals filed a usable price
Nevada NV7not enough hospitals filed a usable price
South Dakota SD7not enough hospitals filed a usable price
Hawaii HI5not enough hospitals filed a usable price
Maine ME5not enough hospitals filed a usable price
Vermont VT5not enough hospitals filed a usable price
Wyoming WY5not enough hospitals filed a usable price
New Mexico NM4not enough hospitals filed a usable price
Rhode Island RI3not enough hospitals filed a usable price
Utah UT3not enough hospitals filed a usable price
Delaware DE1not enough hospitals filed a usable price

Hospitals like yours

The same distribution cut by the kind of hospital. Hospital type and ownership come from CMS; a hospital counts as part of a system when its price file is shared with at least one other hospital under the same brand. The national median is $398.

Cash price by hospital segment. A segment needs at least 20 hospitals to show a figure.
SegmentHospitalsMedian20th–80th
Hospital type
Acute care905$429$150 – $879
Children’s61$740$293 – $2,441
Critical access176$261$136 – $550
Ownership
For-profit76$450$150 – $871
Government160$322$160 – $715
Non-profit906$400$152 – $890
System affiliation
Part of a system966$429$154 – $879
Independent180$243$124 – $688

Cash price vs list price

Median list price (chargemaster)$660
Median cash price$398
Cash as a share of list, median hospital62%

At the typical hospital, asking for the cash price cuts the list price by about 38%. The share is the median of each hospital’s own cash ÷ list ratio, over hospitals that filed both — not the ratio of the two medians above.

The same procedure, inpatient

856 hospitals filed a usable inpatient cash price for this code. The median is $460 and the average of the middle 60% is $470; most fall between $170 and $890.

Cash price percentiles, inpatient, across 856 hospitals. Each figure is a price a hospital filed. 10th: one in ten hospitals charges less; 25th: a quarter charge less; Median: half charge less; 75th: three quarters charge less; 90th: nine in ten charge less.
10th25thMedian75th90th
$112$193$460$767$1,268

The most expensive tenth of hospitals charges at least 11× what the cheapest tenth charges ($112 vs $1,268).

Of the 916 hospitals that filed this code inpatient, 856 gave a usable cash price; 29 carried a plausibility flag, 0 filed a number their own filing marks as not a price, 0 gave an estimate, and 31 a list price only.

How complete is this

1,146 of the 3,956 hospitals with a price file in our corpus (29%) filed a usable outpatient cash price for this code, and those are the hospitals every figure on this page is computed from.

What the 1,266 hospitals that filed this code at all gave us
Usable cash price — counted1,146
Cash price carrying a plausibility flag — shown on the compare tool, excluded here58
A number the filing itself marks as not a price (a placeholder, a ratio) — excluded0
An estimate rather than a filed cash price — excluded0
A list price only, no cash figure — excluded62
Hospitals that filed this code1,266

Sections not shown for this setting

  • Against Medicare: Medicare has no separately payable national outpatient (OPPS) rate for this code, so there is nothing honest to compare against.
  • Since our last snapshot: there is no earlier snapshot at least 90 days older than this one yet.

We last checked these hospitals’ price files for changes between September 4, 2026 and September 24, 2026; the figures were computed September 25, 2026 from filings loaded through September 24, 2026. The percentiles and averages use only the “counted” row.

Related procedures

Part of the Other OR therapeutic nervous system procedures family.

Hospitals file this code under descriptions such as Chemodenervation 1 Extremity Ea Addl 1-4 Muscle.

Method

Source
The machine-readable price files every U.S. hospital is required by CMS to publish, parsed per hospital. Nothing is surveyed, sampled or modelled.
What counts
One cash (self-pay) price per hospital for this code and setting. A hospital’s own filing can rule its number out — a placeholder, a “not applicable” note, a list price standing in for cash — and our plausibility checks can flag a price far below what every other hospital files. Both kinds are disclosed above and excluded from the statistics; on the compare tool a flagged price is still shown.
Statistics
Percentiles are discrete: each is a price some hospital filed. The average is the mean of the prices between the 20th and 80th percentiles. We never publish the plain mean, the minimum or the maximum. A state needs 10 hospitals and a segment 20 to show a figure; otherwise the row shows its count and no number. Medicare is the national unadjusted OPPS rate where one exists.
Names
Procedure names on these pages are our own plain-language titles, not the AMA’s copyrighted CPT descriptors. The code is the identity.

The full rules — sources, statistics, thresholds, limitations — are on the methodology page.

Download this page’s figures: JSON · CSV. Aggregates only — the per-hospital prices are on the compare tool.

Cite: HospitalRates.com, “Botulinum injection, 1-4 muscles, each extra arm or leg (CPT 64643) — cash price report,” computed September 25, 2026. https://hospitalrates.com/procedures/cpt-64643-botulinum-injection-1-4-muscles-each-extra-arm-or-leg