Chemodeneravtion with botulinum toxins has become a standard but expensive part of physiatric practices. They are used for treating migraine, spasticity, neurogenic bladder, dystonia and myofascial pain syndromes for example. Financial considerations increasingly affect which botulinum neurotoxin is administered, how, when and setting of administration. This course will address clinical considerations, but will emphasize differences and financial considerations of toxin injections. Considerations of academic, hospital and private practice settings will be described and discussed. Other aspects of practice that will be considered are education and training, cost, reimbursement and value to systems of healthcare.