Botox (onabotulinumtoxinA) cost per injection and what the patient owes

$6.514 per Unit is Part B's ASP+6% rate for Q4 2026. Once the $283 Part B deductible is met, the patient owes the remaining 20% coinsurance on the drug and its administration, with no annual out-of-pocket maximum to cap it. Full explanation: How Medicare Part B drug cost sharing works →

Medicare pays J0585 per Unit billing unit, not per vial or per treatment session. Botox's labeled dose depends on the indication treated: 155 Units for chronic migraine, 100 Units for overactive bladder, 200 Units for neurogenic detrusor overactivity in adults, up to 400 Units for limb spasticity. The allowed drug amount moves with the protocol dose instead of staying fixed the way a flat-dose biologic does. At the reference 155-Unit chronic migraine dose, the drug alone allows $1,009.67; adding the 64615 chemodenervation procedure (non-facility PFS, $156.98) and the 45-Unit JW line for the discarded remainder of the 200-Unit vial ($293.13) brings the claim to $1,459.78 allowed, and the patient's 20% coinsurance after the deductible is $291.96.

Daxxify (daxibotulinumtoxinA-lanm, J0589) carries no ASP+6% entry in this quarter's pricing file and is omitted from this table. None of these billing-unit definitions convert to another product's Units: a Botox Unit, a Dysport Unit and a Xeomin Unit are different potencies measured by different assays. Never substitute a dose in Units from one product for a dose of another.

For the reference patient (155 Units, drug + the 64615 chemodenervation code), Medicare allows $1,459.78, and the Part B coinsurance on that is $291.96. Plans A, B, C, D, F, G, M and N cover that coinsurance in full, so those patients owe nothing per dose once the $283 deductible is met. Plans K and L do not. Because a chronic migraine dose is given no sooner than every 12 weeks, up to four times a year, the deductible column is what decides most claims for the first dose of the plan year. The dose that lands before the deductible is met costs a Plan K patient $400.68; the dose after it costs $145.98. Unequal charges every twelve weeks, not one recurring number. See what each Medigap plan (A–N) owes on this claim →

Only the letters that leave this patient a balance are listed. The full A–N grid, the high-deductible variants, Plan N’s office-visit carve-out and the MACRA restriction on Plans C and F are at Medigap Plans A–N.

Commercial payers negotiate their own rate for J0585, not ASP+6%. Our corpus holds published rates from 37 payers, including Aetna, UnitedHealthcare, Cigna, Anthem, Regence, Premera and Kaiser. Aetna’s median is $6.51 per Unit against Medicare’s $6.514, putting a 155-Unit chronic migraine dose at $1,009.05 before benefits. Rates move by state as well as by payer, which is why the estimator above takes one. The chemodenervation procedure carries its own commercial copay or coinsurance separate from the drug line, and the BOTOX Savings Program, where the patient is eligible, applies to both. What the patient owes then depends on their specific benefits. Full explanation: How commercial drug reimbursement works →

Medicare pays the same ASP+6% rate for the Botox drug itself no matter where it's given. The chemodenervation procedure follows the site treated: 64615 for chronic migraine, 64616 for cervical dystonia, 52287 for the bladder indications, 64642–64647 for limb spasticity. Most of these are short in-office injections billed under the physician fee schedule's non-facility rate rather than a hospital-outpatient facility fee. The bladder indications are injected cystoscopically and are more often done in a procedure suite. Some commercial payers apply a site-of-care rule to onabotulinumtoxinA; our coverage corpus shows 4 of 29 policy sets carry an explicit site-of-care rule. Our data doesn't carry a Botox-specific hospital-outpatient facility rate, so this estimator only prices the office/physician-fee-schedule path.

Place of service (POS) is what drives that rate split. POS 11 (office) prices the admin code at the non-facility physician fee schedule rate, which is the path this estimator prices. A site-of-care rule that sends the same claim to POS 19 (off-campus hospital outpatient), POS 22 (hospital outpatient) or POS 24 (ambulatory surgical center) moves the admin code to the facility rate instead: a different number for the same CPT code. Confirm the POS on the claim before comparing an admin-fee estimate against what a payer actually paid.

The current quarter's payment limit carries three decimal places in the ASP pricing file: $6.514 per Unit. The worked examples on this page use that figure; earlier quarters above are shown to two decimals as published. Applied to the same 155-Unit chronic migraine dose, the Q3 2026 rate ($6.51 per Unit, rounded) allows $1,009.05; the Q4 2026 rate, precise at $6.514, allows $1,009.67. Use the quarter that is actually in effect for the claim's date of service.

On a commercial plan, the BOTOX Savings Program (BOTOX Complete) can take both the drug and the injection-procedure copay, coinsurance or deductible down to $0, up to $4,000 a year (the spasticity indications carry their own cap of $1,000 per treatment and $5,000 a year), for as many as 5 treatments in a 12-month period across all indications. It excludes Medicare, Medicaid, TRICARE, VA and other federal program patients.

There is a free-drug route from the manufacturer: myAbbVie Assist ships Botox at no cost to qualifying uninsured patients (limited or no coverage), with no stated program limit, but it covers only the drug, not the injection procedure or an office-visit fee. On Medicare, neither program applies at all: the Savings Program excludes federal program patients by design, and myAbbVie Assist reaches only the drug, never the Part B coinsurance. A diagnosis-matched foundation fund is the only path on Medicare, when one is open. See every program for this patient, with current status →

Sources: CMS ASP pricing files (Q4 2026); Medicare physician fee schedule (64615, 52287, national non-facility); Medicare Part B deductible (2026); Medicare Rights Center 2026 Medigap plan benefits chart; 37 commercial payer published price files; BOTOX Savings Program and myAbbVie Assist terms and status (the site's programs bundle, generated from the live programs corpus).

Reviewed September 20, 2026 by Erin Rose, CareCost Estimate founder. Methodology →