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Few studies have focused on the cost of acupuncture treatments although acupuncture has become popular in the United States (U.S.).The purpose of the current study was to examine the out-of-pocket costs incurred from acupuncture services based on an online website,OkCopay.com.We examined descriptive statistics (range,median and 20％ intervals) for the cost of acupuncture first-time visits and follow-up visits in 41 metropolitan regions in the U.S.The acupuncture prices of 723 clinics throughout 39 metropolitan regions were included,except for Birmingham,Alabama and Detroit,Michigan as there was no online data available at the time of the study for these two regions.The cost range for a first-time acupuncture visit was $15-400;the highest median was $150 in Charleston,South Carolina,while the lowest was $45 in St.Louis,Missouri.The top 10 cities for the highest median were:Baltimore,Washington,D.C.,New York,San Francisco,San Jose,Boston,Atlanta,Seattle,Portland and Indianapolis,with the median $120,while the median for all 723 clinics was $112.For the follow-up visits,the cost range was $15-300;the highest median was $108 in Charleston,South Carolina,and the lowest $40 in Miami,Florida.The 10 cities with highest median follow-up acupuncture visit costs were:New York,Baltimore,New Orleans,Washington,D.C.,Philadelphia,San Francisco,San Jose,Seattle,Boston and Atlanta,with the median $85,while for all 723 clinics the median price was $80.The estimation of the average gross annual income of each acupuncturist from the regions studied was $95,760,while the total annual cost of patients seeking acupuncture services in the U,S.was about $3.5 billion in 2018.