Fee Schedule for Self-Pay Patients
Chiropractic Health & Wellness Clinic
New Patient Exam
- Focused (99202): $55
- Expanded (99203): $133
- Comprehensive (99204): $204
Re-Exam
- Focused (99212): $55
- Expanded (99213): $86
- Comprehensive (99214): $131
X-Rays
- Cervical (72040): $60
- Thoracic (72070): $80
- Lumbar (72100): $80
Chiropractic Adjustment/Manipulation
Spinal
- 1-2 Regions (98940): $45
- 3-4 Regions (98941): $55
- 5 Regions (98942): $65
Extremity
- Extremity Treatment (98943): $35
Acupuncture
- Acupuncture (20 minutes) (97810): $75
- Acupuncture (40 minutes) (97811): $115
Therapies
- Cold Laser (97039): $35
- Muscle Stimulation (97014): $20
- Intersegmental Traction (97012): $20
- Therapeutic Ultrasound (97035): $35
- Kinesiotaping (97112): $41
Massage Therapy
- Massage Therapy (15 minutes) (97140): $30
- Massage Therapy (30 minutes) (97140): $40
- Massage Therapy (60 minutes) (97140): $70
- Massage Therapy (90 minutes) (97140): $105
- Massage Therapy (120 minutes) (97140): $140
You have the right to receive a “Good Faith Estimate” explaining how much your medical care will cost.
Under the law, health care providers need to give patients who do not have insurance or who are not using insurance an estimate of the bill for medical items and services.
- You have the right to receive a Good Faith Estimate for the total expected cost of any non-emergency items or services. This includes related costs like medical tests, prescription drugs, equipment, and hospital fees.
- Make sure your health care provider gives you a Good Faith Estimate in writing at least 1 business day before your medical service or item. You can also ask your health care provider, and any other provider you choose, for a Good Faith Estimate before you schedule an item or service.
- If you received a bill that is at least $400 more than your Good Faith Estimate, you can dispute the bill.
- Make sure to save a copy or a picture of your Good Faith Estimate.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises or call 1-800-985-3059.
