Context: Low back pain (LBP) has a major economic impact in the United States, with total costs related to this condition exceeding $100 billion per year. Objective: To estimate the cost of standard care compared to standard care plus osteopathic manipulative treatment (OMT) for acute LBP of less than 6 months' duration. Methods: A retrospective review of electronic medical records from patients who visited Florida Hospital East Orlando in Orlando. All patients had LBP of less than 6 months' duration and had received care between January 1, 2002, and December 31, 2005. The control group comprised patients who received standard care; the study group consisted of patients who received OMT in addition to standard care. Healthcare utilization (eg, radiologic scans, prescriptions) was determined by "episodes of care," and costs were averaged per patient. Results: A total of 1556 patients and 2030 episodes of care met inclusion criteria. Compared with subjects in the control group, individuals in the OMT group had an average of 0.5 more office visits per EOC, resulting in 38% more office visits. However, OMT patients had 18.5% fewer prescriptions written, 74.2% fewer radiographs, 76.9% fewer referrals, and 90% fewer magnetic resonance imaging scans. In the OMT group, total average costs were $38.26 lower (P=.02), and average prescription costs were $19.53 lower (P <.001). Patients in the OMT group also had $63.81 less average radiologic costs ( P <.0001). Conclusion: Osteopathic manipulative treatment may reduce costs for the management of acute LBP. Further research in a prospective study is needed.