98940

Chiropractic manipulative treatment, 1-2 spinal regions

Medicare pricing data for 28,047 providers across 52 states

🤖AI Overview

This is one of the most commonly performed procedures in Medicare, with 4.1 million services annually. Even small pricing inefficiencies here affect millions of patients. 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

Chiropractic manipulative treatment, 1-2 spinal regions (HCPCS code 98940) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $27.26, but hospitals typically charge $47.66 — a 1.7x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.45

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $27.26, your out-of-pocket cost would be approximately $5.45. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$27.26
Average Hospital Charge
$47.66
Markup Ratio
1.7x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$47.66
Medicare Allowed$27.26
Medicare Payment$19.02

Hospitals charge 1.7x more than what Medicare allows for this procedure. Medicare actually pays $19.02 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$35$6915014,100+28.8%
New Jersey$30$67954104,140+8.7%
District of Columbia$30$4812740+8.2%
California$29$511,920287,308+7.1%
New York$29$461,685632,672+6.8%
Massachusetts$29$5455579,626+5.6%
Hawaii$29$47595,007+5.2%
Connecticut$29$5637479,510+4.7%
Maryland$29$4833151,005+4.6%
Rhode Island$28$557711,977+1.4%
Washington$28$5088890,580+1.2%
Colorado$28$4846547,850+0.9%
New Hampshire$27$4711711,645+0.5%
Delaware$27$5912810,284+0.1%
Virginia$27$4553084,849-0.4%
Minnesota$27$481,243108,031-0.8%
Montana$27$4421129,109-0.9%
Nevada$27$5613316,600-0.9%
Puerto Rico$27$32652,148-1.2%
Florida$27$541,699203,521-1.3%
Vermont$27$45814,984-1.3%
South Dakota$27$4229236,531-1.4%
Illinois$27$451,365213,005-1.5%
North Dakota$27$5230763,121-1.6%
Pennsylvania$27$451,320148,086-1.8%
Arizona$27$49509106,042-2.2%
Maine$27$4615512,346-2.4%
Michigan$27$4497162,998-2.6%
Texas$27$441,118104,828-2.6%
Oregon$26$4843434,499-3.1%
Wyoming$26$428022,236-3.2%
Wisconsin$26$531,251174,516-3.6%
North Carolina$26$4575874,798-3.9%
Utah$26$5916912,822-4.0%
Georgia$26$4659662,926-4.1%
Ohio$26$451,074161,984-4.4%
Iowa$26$42895136,664-4.7%
Kansas$26$4552784,598-4.7%
Nebraska$26$4740464,812-4.8%
South Carolina$26$4342461,991-5.1%
New Mexico$26$44907,474-5.3%
Indiana$26$4048358,748-5.6%
Missouri$26$4268882,543-5.6%
West Virginia$26$4212617,052-5.9%
Idaho$26$4119813,647-5.9%
Tennessee$26$4342269,482-5.9%
Louisiana$26$4223735,748-6.1%
Kentucky$26$4246979,584-6.3%
Oklahoma$26$5030473,482-6.4%
Arkansas$25$4925239,721-6.7%
Alabama$25$3529132,138-7.3%
Mississippi$25$4113325,903-8.3%

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

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