New procedures, medication and treatment options have vastly improved the medical profession’s ability to diagnose and cure disease, repair damage from accident or injury, and test for ailments and conditions whose early detection and management helps save lives.
There is a price to pay for all those medical advances.
The average family of four with health insurance in 2023 paid $31,065 in medical expenses, including insurance premiums, up from $28,310 in 2021. Those without insurance often must make choices between getting healthcare or paying bills.
The cost of a doctor visit is hard to quantify because there are many factors that go into what the final bill is. The average cost of a doctor visit, not including procedures or tests, range from $80-$170 across the U.S.
Factors that determine the cost include:
- The purpose of the visit
- What tests or procedures are involved
- Amount of time spent with the provider
- What state you live in
Someone without insurance pays the full amount; someone with insurance pays a small copay, or in some cases nothing, with their insurance company picking up the rest of the tab.
Approximately 29.6 million American adults between 18-64 and about 3.1 million of those under 17 do not have health insurance. More than 90% of Americans older than 65 are covered by Medicare, which helps pay for doctor visits and other medical costs. Still, 44% of Americans with health Insurance say some aspects of healthcare still aren’t affordable.
As the cost of health insurance premiums rise, along with copays and deductibles, Americans are finding health insurance taking an increasing bite out of their budget. There isn’t just one cheapest way to see a doctor without health insurance. It depends on many factors.
Average Doctor Visit Costs
Doctor visit costs for someone without insurance can be 2-5 times higher than the cost for someone who has it, depending on the medical issue or procedure. Some people without insurance opt for an urgent care clinic or the emergency room. Urgent care can be cheaper than visiting a primary care provider, but the emergency room is not. We’ll talk about urgent care later, but first it’s important to understand what a doctor visit costs and what goes into it.
The most expensive state for a doctor visit is Alaska, where the average cash cost for the most basic visit is $112-$172. The least expensive state is Iowa, where the range is $79-$121. The range across the U.S. is somewhere in between those two states.
Most visits go beyond that basic visit cost. For example, the average physical exam, a simple but time-consuming visit, costs an uninsured patient an average of $397. That includes the initial visit, the bloodwork and other tests that go with a physical, and usually an administrative fee charged by the doctor’s office. That figure is just an average, and doesn’t consider where the person lives, what other procedures may be required if issues are uncovered by the physical, and even the billing practices at the doctor’s office.
Many people without insurance opt to go to an urgent care clinic or emergency room. Knowing what it will cost to visit a healthcare provider may save you money.
The No Surprises Act, which went into effect Jan. 1, 2022, requires every hospital, medical and dental provider in the U.S. to provide clear, accessible pricing information to patients. Before the law went into effect, people without insurance had no way to find out what a procedure or doctor visit would cost.
Under the law, one way to estimate the cost of a doctor visit or medical procedure is the simplest: just ask the doctor.
Once you schedule a procedure, medical and dental providers must give you a good faith estimate of the cost at least three days in advance of it. But they’re only required to if you ask. If the actual cost is more than $400 above the estimate, you can dispute the additional charges.
Of course, you must schedule the procedure before getting the estimate, so if you’re shopping around, that doesn’t help. Hospitals are required to have a searchable database of the cost of common procedures, but those without insurance who want to know the cost of a doctor visit can’t find out until they make the appointment.
The good faith estimate also doesn’t cover any issues that the healthcare provider may find during the exam or procedure, or future care if it’s required.
There are other ways, though, to estimate how much a doctor visit or other medical procedure will cost.
The American Medical Association publishes a list of CPT codes for most preventive services and office procedures. The codes make billing, particularly with insurance companies, consistent. But they are also publicly available and can help patients estimate costs. To a point. The information on these payment charts is broken down into categories and includes guidelines for what a healthcare provider can charge an insurance company. The codes are revised yearly. For instance, telehealth codes were added in 2023.
The codes are also complicated – there are more than 100,000. They are very specific. The code for an office visit for an established patient (99212), is $25.66 ($39.11 if the provider is an OB-GYN, which has its own category), but that’s simply for the 10-19 minutes the patient spends with the doctor. It doesn’t include tests, procedures, or any extra time required. The most common CPT providers use for an office visit is 99214, which is $70 ($89 for OB-GYN). Are you over 65 and getting a preventative physical? That is also $70 from most providers, but if it’s with an OB-GYN, it’s $92.67. Again, that’s only for the visit, not any add-ons, and it’s for an established patient. Most visits will cost more.
New patients pay more for a visit since the provider must spend more time with them. The lowest-cost new patient visit is $59.78 ($78.72 OB-GYN), but it will likely cost more.
Different healthcare providers use the codes differently, and few use the code for the least expensive visit. Aside from the cost of the office visit, tests can ramp up the cost fast. A routine blood panel and urinalysis is $318-$650; a lipid panel for cholesterol is $128-$200; a thyroid test is $97-$195.
Healthcare Blue Book Prices for Common Doctor Office Visits
A good way to estimate the cost of healthcare services is the Healthcare Blue Book, an online guide to healthcare pricing, The site gives an estimated “fair price,” based on the typical fees physicians accept from insurance companies. This tool is most helpful for people with health insurance. Many physicians charge uninsured patients more for the same procedure.
Providing your zip code gives you a more accurate estimate for costs in your area. Accessing Healthcare Blue Book requires registering, but the account is free. You are allowed a limited number of searches per month.
- Office Visit, Established Patient, 10 minutes (the lowest level) – $89
- Office Visit, New Patient, 20 minutes (the lowest level) – $114
- Office Visit, New Patient, 60 minutes – $341
- Flu shot – $39
- Tetanus shot – $42 at walk-in clinic, $55 at doctor’s office
- Eye Examination, New Patient – $369
Private Insurance Deductibles, Co-Pays, and Co-Insurance
Almost all private insurance policies provided by an employer require that the insured person pay a co-pay when visiting a doctor or any other healthcare provider. The amount varies depending on the insurance plan, but co-pays for private insurance average $27 for primary care and $44 for specialty care.
Most plans also require that the insured pay a deductible before the insurance provider covers anything. The average deductible for an employer-based plan is $1,434. Deductibles vary widely among plans, and some benefits are available even before the deductible is met. Co-pays may or may not be included in meeting the deductible.
Co-insurance charges are usually stipulated as a percentage of the total bill, and average 19% for primary care and 20% for specialty care. If you have an 80/20 policy, it means that you pay 20% of the bill, and the insurance company pays 80%, but only after you’ve paid a co-pay and met the required deductible.
When a doctor orders tests from a diagnostic facility, it may be paid for by insurance, depending upon the specific test and insurance policy. If a particular policy does not cover lab tests, the bill must be paid by the patient.
Individual Insurance (Health Insurance Marketplace)
About 5.8% of the adults in the U.S. are covered by individual insurance from the Health Insurance Marketplace (under the Affordable Care Act). The ACA makes it easier for individuals who aren’t covered by an employer to buy their own health insurance. More than 80% of those who have Marketplace insurance get a subsidy that is aimed at making the monthly premium affordable for their income.
Co-pays average 10%-40% of the visit or procedure. Deductibles are often higher than those with private insurance plans, the average being $2,825.
How Much Do Doctor Visits Cost Without Insurance?
It’s no surprise that people without insurance skip needed medical care. The Commonwealth Fund biennial health insurance survey found that 59% of uninsured people surveyed had a medical problem but didn’t visit a doctor or clinic. The federal Centers for Disease Control found that while 87.9% of people with some type of health insurance visited a doctor in 2022, only 52.6% of people without insurance did. The 2022 number represents a 6% decrease in uninsured people visiting a doctor from 2019.
If you visit a doctor and don’t have insurance, you will have to pay out of pocket. While the visit may not technically cost more than it would for someone who has insurance, their insurance pays most, or all, of the cost.
If you are a new patient visiting a doctor, that visit will likely cost anywhere from $150-$400, or more, depending on what medical issues you may have and what treatment procedures are required. For instance, the cost of a physical exam averages $387, but if you have health problems, it will cost a lot more.
Factors that determine how much a doctor visit costs include:
- Not only what state or city you live in, but where you get care. Nonprofits or community health organizations often have lower prices.
- Extent of care. A simple checkup is much cheaper than a full-blown exam with blood and laboratory tests, or other diagnostic tests. The more the provider must do, the more it will cost you.
- Length of visit. The shorter the visit, the cheaper it is. A 10-15 minute visit generally costs less than $100.
- Insurance status. Your out-of-pocket costs are determined by your insurance coverage. If you don’t have health insurance, you will be responsible for the full cost. Depending on what your visit is for, if you have insurance, it may or may not cover the cost.
Of course, a doctor visit can lead to other procedures and costs.
If you are shopping around for a healthcare professional, and don’t have insurance, inquire with providers about whether they have programs to help with costs. Many providers have a sliding scale, depending on income. Many also offer installment payment plans. We’ll talk about more about this a little farther down.
Cost of Visiting Your Doctor vs. Urgent Care
Urgent care clinics can be found in almost any community. According to the Urgent Care Association, there are about 14,500 urgent care clinics in the U.S. and 26.5% of the adult population visited an urgent care clinic in 2022. Urgent care clinics are usually staffed by physician assistants and nurse practitioners, and sometimes by doctors. You don’t need an appointment to be treated at one.
Reasons to visit an urgent care clinic are:
- You are sick or injured when your primary care provider’s office is closed, or you can’t get an appointment.
- You don’t have insurance or are paying out-of-pocket for some reason.
Reasons to go to a primary care provider:
- You have a chronic or long-term illness.
- You have health insurance, and the doctor is in your network.
- You want to talk to someone who is familiar with your medical and health history.
Urgent care clinics are sometimes open 24/7, but even if they aren’t, they are open on weekends and at night, and you can walk in without an appointment. They treat non-chronic, simple illnesses, like the flu, a bad cold, fever, nausea, bronchitis, strep throat, rashes, allergies, infections, cuts, animal stings and bites, and sprains. They also give vaccines. Some have X-ray and MRI capabilities, but in other cases they may send you to the emergency room for those diagnostics.
An urgent care clinic is often cheaper than a visit to a primary care provider because many primary care providers add administrative costs to healthcare bills. If you have insurance, that doesn’t matter, because your insurance company is paying most of the bill. If you’re paying out of pocket, though, you want the cheaper option.
The average out-of-pocket cost for an urgent care clinic visit ranges from $80-$280 for something simple, to $140-$440 for something more complicated, according to Mira Healthcare research. The average out-of-pocket cost of a visit to a primary care provider is $300-$600.
That said, additional diagnostics or treatment can add to the cost of an urgent care clinic, and if they send you to the emergency room, the cost can go up fast.
Speaking of the emergency room, if you have a medial issue that an urgent care clinic can treat, it is always cheaper, and faster, to go to urgent care than the emergency room. The emergency room is for serious illness or injury that needs immediate treatment.
Doctor Office Visits Can Be Negotiated
It is important to remember that doctor visit fees can be negotiated, both before and even after an office visit. Discounts are widely available for self-payers, and like any other consumer product or service, individuals can shop around to find the best price for a particular procedure, especially if they know in advance what the average charge is for a particular service, or what other providers in the area are asking.
Some physicians have even decided to opt out of the current insurance payment model and have returned to a less administratively complex, fee-for-service approach. Others have elected to do away entirely with fees, charging their patients one annual price for all services rendered during the year.
Savvy consumers will benefit from communicating with their insurance companies as well as with their own healthcare providers so that they have the best available estimate of what their doctor visits will cost them, and whether they are getting the best value for their money.
Some tips for people who are having trouble paying medical bills, or can’t come up with the money to pay for a doctor visit:
- Talking to a professional debt relief company experienced in negotiating medical bill payments on your behalf may be an option.
- Either debt settlement or debt consolidation may be an appropriate option to help settle overdue or unmanageable accounts.
- Contact a The counselor may recommend a debt management program, which won’t cover medical bills, but will help you reduce, and eventually eliminate, credit card debt.
- Patients who qualify for Medicaid, which is the federal/state insurance program for low-income individuals and families, can have their doctor visits covered. Eligibility requirements vary from state to state.
- Consider other ways to reduce healthcare costs, including communicating with your doctor about reducing costs, and taking preventive measures that keep you healthier.
About The Author
Bill “No Pay” Fay has lived a meager financial existence his entire life. He started writing/bragging about it in 2012, helping birth Debt.org into existence as the site’s original “Frugal Man.” Prior to that, he spent more than 30 years covering the high finance world of college and professional sports for major publications, including the Associated Press, New York Times and Sports Illustrated. His interest in sports has waned some, but he is as passionate as ever about not reaching for his wallet. Bill can be reached at [email protected].
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