97811

Acupuncture, each additional 15 minutes

Medicare pricing data for 769 providers across 36 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Acupuncture, each additional 15 minutes (HCPCS code 97811) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $29.88, but hospitals typically charge $98.98 — a 3.3x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.98

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $29.88, your out-of-pocket cost would be approximately $5.98. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$29.88
Average Hospital Charge
$98.98
Markup Ratio
3.3x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$98.98
Medicare Allowed$29.88
Medicare Payment$23.33

Hospitals charge 3.3x more than what Medicare allows for this procedure. Medicare actually pays $23.33 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
New York$33$867419,293+9.2%
District of Columbia$32$601396+7.8%
New Jersey$31$1808218,979+3.2%
Virginia$31$585200+2.8%
California$31$7810816,624+2.5%
Connecticut$30$1348525+1.3%
Pennsylvania$29$79493,280-1.3%
Maryland$29$80222,659-1.8%
Massachusetts$29$91151,525-2.3%
Michigan$29$61272,904-2.8%
Nevada$29$832321-3.5%
Illinois$29$6481,756-3.7%
Texas$28$169101,159-5.1%
Delaware$28$675263-6.4%
Hawaii$28$344252-6.4%
Minnesota$28$1031294,323-7.7%
Washington$28$7217760-7.8%
Missouri$27$574234-8.7%
North Carolina$27$5513398-8.7%
Wisconsin$27$40221,171-8.7%
Alabama$27$452133-9.3%
Georgia$27$9181,102-9.4%
Florida$26$65323,770-11.6%
New Hampshire$26$514451-11.6%
Ohio$26$55101,718-12.3%
Arizona$26$83222,070-12.4%
Colorado$26$48211,750-14.1%
New Mexico$26$597826-14.2%
Oregon$26$35122,109-14.2%
Tennessee$26$434122-14.3%
Nebraska$26$76318-14.4%
Vermont$25$31177-16.1%
Maine$25$633351-17.5%
Kentucky$25$65254-17.7%
Idaho$24$67215-19.8%
Indiana$20$453137-32.2%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber