Botox injections to relax facial muscles on one side at Good Samaritan Hospital

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

C CHEMODENERVATION OF MUSCLE INNERVATED BY FACIAL NERVE, UNILATERAL

Puyallup, WA

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How this price compares nationally

Good Samaritan Hospital’s median price of $927 is 136% above the median hospital's median price ($393), higher than 78% of the 1,913 hospitals reporting CPT 64612. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting CPT 64612 at Good Samaritan Hospital

Negotiated rates from the hospital’s own file: 11 payers, 24 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	Molina apple health fee schedule · outpatient	$309.03	$309.03	$309.03 – $309.03
2	UnitedHealthcare apple health fee schedule · outpatient	$333.75	$333.75	$333.75 – $333.75
3	Aetna medadvantage fee schedule · outpatient	$361.60	$361.60	$361.60 – $361.60
4	Regence medadvantage fee schedule · outpatient	$361.60	$361.60	$361.60 – $361.60
5	UnitedHealthcare medadvantage fee schedule · outpatient	$365.11	$365.11	$365.11 – $365.11
6	Molina medadvantage fee schedule · outpatient	$368.62	$368.62	$368.62 – $368.62
7	WellCare medadvantage fee schedule · outpatient	$368.62	$368.62	$368.62 – $368.62
8	Premera hmo fee schedule · outpatient	$509.35	$509.35	$509.35 – $509.35
9	Ambetter coordinated care exchange fee schedule · outpatient	$702.13	$702.13	$702.13 – $702.13
10	Regence blue high performance fee schedule · outpatient	$972.39	$972.39	$972.39 – $972.39
11	Regence mcc/ahn fee schedule · outpatient	$972.39	$972.39	$972.39 – $972.39
12	Regence realvalue fee schedule · outpatient	$1,000	$1,000	$1,000 – $1,000
13	Premera signature fee schedule · outpatient	$1,082	$1,082	$1,082 – $1,082
14	Premera prime fee schedule · outpatient	$1,107	$1,107	$1,107 – $1,107
15	Regence commercial fee schedule · outpatient	$1,111	$1,111	$1,111 – $1,111
16	Kaiser ppo fee schedule · outpatient	$1,259	$1,259	$1,259 – $1,259
17	First Health all commercial plans percent of total billed charges · inpatientfrom % of charges	$1,300	$1,300	$1,300 – $1,300
18	First Health all commercial plans percent of total billed charges · outpatientfrom % of charges	$1,300	$1,300	$1,300 – $1,300
19	MultiPlan all commercial plans percent of total billed charges · inpatientfrom % of charges	$1,300	$1,300	$1,300 – $1,300
20	MultiPlan all commercial plans percent of total billed charges · outpatientfrom % of charges	$1,300	$1,300	$1,300 – $1,300
21	Premera other commercial plans fee schedule · outpatient	$1,360	$1,360	$1,360 – $1,360
22	Aetna all commercial plans fee schedule · outpatient	$1,377	$1,377	$1,377 – $1,377
23	Cigna all commercial plans fee schedule · outpatient	$1,473	$1,473	$1,473 – $1,473
24	UnitedHealthcare all commercial plans fee schedule · outpatient	$1,566	$1,566	$1,566 – $1,566

Last updated: Aug 27, 2026

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