How much does a Office visit, established patient (30-39 min) typically cost in the United States?

Across 2,070 U.S. hospitals in 52 states, the modeled national fair BaseRate for Office visit, established patient (30-39 min) is $123, with most hospital negotiated prices falling between $74 and $255.

Why do hospital prices for Office visit, established patient (30-39 min) vary across facilities?

Commercial rates are negotiated individually between hospital systems and insurers, creating wide local dispersion even within the same metro area. Comparing facility-specific cash and in-network rates before scheduling care helps avoid overpaying.

National price data · 2,070 hospitals

Office visit, established patient (30-39 min) cost

What a office visit, established patient (30-39 min) costs across the U.S. — and the fair price to aim for.

Near Fair BaseRate Benchmark

1.00×vs. Fair Market Price

Typical commercial prices here match the fair market benchmark (1.00×) after accounting for local nurse/doctor wages and patient complexity.

86/100 · Verified

86/100Hover Any Check Below to See How Prices Were Audited

File Completeness90

Price Logic88

Peer Alignment86

Clean Billing83

Real Cash Discount84

Regional Value Leader

Balances commercial hospital prices against CMS clinical safety, infection control, and patient experience.

Behavioral Pricing FingerprintConsistent Department Multiples

Aligned Regional Benchmark Peer

Penn State Health St. Joseph prices shoppable and inpatient services (1.0× to 1.0× Medicare, divergence 1.00×) in alignment with regional hospital peers (0.93× Fair BaseRate). Reviewing plan-specific negotiated rates and cash discounts helps lock in the lowest out-of-pocket tier.

#46 of 134 in PA · 33rd State Percentile#875 of 3,385 in U.S. · 25th National Percentile

Advantage

Where They're Good (Patient & Payer Edge)

Elective shoppable care is priced 7% below peer Fair BaseRate (0.93×)
Self-pay cash beats commercial insurance on 72% of shoppable procedures (99/100 Cash Honesty)
CMS clinical safety score (64/100 safety score) with 74% patient recommendation
IRS 501(c)(3) charity care provides free care up to 200% FPL and discounted care up to 400% FPL (25.7% AGB cap)

Watchout

Where You Can Get Burned (Markup Traps)

Outpatient surgery & OR suites carry a 1.2× markup over Medicare rates
Commercial insurance median sits at 0.94× Fair BaseRate (1.0× Medicare), so insured patients should always compare the self-pay cash price before paying.
Even at low-cost facilities (1.00× Fair BaseRate), out-of-network or unnegotiated chargemaster bills can exceed commercial medians — confirm in-network status or request a self-pay cash quote up front.
Consolidated metro market (HHI 5,495) limits in-network hospital competition (Highly Concentrated Monopoly (>2,500))

Front-Door ShoppableElective / Imaging

1.0× Medicare

Pre-scheduled outpatient procedures where patients can comparison-shop.

Back-Door Captive & ER1.00× Divergence

1.0× Medicare

Emergency, inpatient DRG, lab, and specialty drug lines billed after admission.

Quantile Tail Spread+3% Upper Tail

Q25 0.82× · Q50 0.94× · Q75 0.97×

Detects median-gaming when upper-quartile codes spike above the p50 median.

Select any lens to inspect department markups, federal cost accounting, or insurer discounts.

Department & Integrity Multiples (vs. CMS Medicare Cost Anchor) Green ≤1.3× · Teal 1.3–1.8× · Amber 1.8–2.5× · Rose >2.5×

Front-Door Shoppable CareFront-Door Shoppable

1.0× MedicareGood

Outpatient Surgery & ORBack-Door Captive

1.2× MedicareGood

Diagnostic Imaging (CT/MRI)Front-Door Shoppable

0.9× MedicareGood

Back-Door Captive ER VisitsBack-Door Captive

1.4× MedicareGood

Inpatient Lab & PathologyBack-Door Captive

1.2× MedicareGood

Specialty & Infusion Drugs (J-Codes)Back-Door Captive

1.0× MedicareGood

Self-Pay Cash Honesty & 501(r)Integrity & Outcomes

72% Cash Edge · 99/100Good

CMS Clinical Safety & Star ValueIntegrity & Outcomes

3 CMS · 64/100Elevated

National Geographic Price Intelligence · 50-State + DC/PR Cartogram

National State Price Index Heatmap · Office visit, established patient (30-39 min)

State commercial price index vs. U.S. median (1.00×) and average Medicare multiple across all 53 priced states & territories

<0.93× Below Fair Price 0.93–1.05× Near Average 1.05–1.18× Elevated >1.18× High-Cost State

AK2.05× 1.9× Med ME1.13× 1.0× Med WA0.90× 0.8× Med ID1.00× 0.9× Med MT1.07× 1.0× Med ND0.98× 0.9× Med MN1.34× 1.2× Med WI0.96× 0.9× Med MI0.85× 0.8× Med VT0.99× 0.9× Med NH1.07× 1.0× Med OR1.23× 1.1× Med NV0.78× 0.7× Med WY1.04× 0.9× Med SD1.28× 1.2× Med IA1.08× 1.0× Med IL1.05× 1.0× Med IN0.99× 0.9× Med OH0.93× 0.8× Med PA0.75× 0.7× Med NY0.98× 0.9× Med MA1.30× 1.2× Med CA0.89× 0.8× Med UT1.00× 0.9× Med CO1.04× 0.9× Med NE1.20× 1.1× Med MO0.76× 0.7× Med KY0.71× 0.6× Med WV0.68× 0.6× Med VA0.84× 0.8× Med MD1.22× 1.1× Med NJ1.00× 0.9× Med CT0.99× 0.9× Med AZ0.46× 0.4× Med NM0.77× 0.7× Med KS0.97× 0.9× Med AR1.12× 1.0× Med TN0.67× 0.6× Med NC0.98× 0.9× Med SC1.11× 1.0× Med DE1.17× 1.1× Med DC1.31× 1.9× Med RI1.13× 1.0× Med OK0.97× 0.9× Med LA0.64× 0.6× Med MS0.99× 0.9× Med AL0.88× 0.8× Med GA0.97× 0.9× Med HI0.80× 0.7× Med TX1.54× 1.4× Med FL1.15× 1.0× Med PR0.81× 0.7× Med

AZ0.46×0.4× Med LA0.64×0.6× Med TN0.67×0.6× Med WV0.68×0.6× Med KY0.71×0.6× Med PA0.75×0.7× Med MO0.76×0.7× Med NM0.77×0.7× Med NV0.78×0.7× Med HI0.80×0.7× Med PR0.81×0.7× Med VA0.84×0.8× Med MI0.85×0.8× Med AL0.88×0.8× Med CA0.89×0.8× Med WA0.90×0.8× Med OH0.93×0.8× Med WI0.96×0.9× Med GA0.97×0.9× Med KS0.97×0.9× Med OK0.97×0.9× Med NC0.98×0.9× Med ND0.98×0.9× Med NY0.98×0.9× Med CT0.99×0.9× Med IN0.99×0.9× Med MS0.99×0.9× Med VT0.99×0.9× Med ID1.00×0.9× Med NJ1.00×0.9× Med UT1.00×0.9× Med CO1.04×0.9× Med WY1.04×0.9× Med IL1.05×1.0× Med MT1.07×1.0× Med NH1.07×1.0× Med IA1.08×1.0× Med SC1.11×1.0× Med AR1.12×1.0× Med ME1.13×1.0× Med RI1.13×1.0× Med FL1.15×1.0× Med DE1.17×1.1× Med NE1.20×1.1× Med MD1.22×1.1× Med OR1.23×1.1× Med SD1.28×1.2× Med MA1.30×1.2× Med DC1.31×1.9× Med MN1.34×1.2× Med TX1.54×1.4× Med AK2.05×1.9× Med

5 Lowest-Price States (Confounder-Isolated Value Leaders)

AZ0.46×(0.4×)LA0.64×(0.6×)TN0.67×(0.6×)WV0.68×(0.6×)KY0.71×(0.6×)

5 Highest-Markup States (Strict Bill Audit Recommended)

AK2.05×(1.9×)TX1.54×(1.4×)MN1.34×(1.2×)DC1.31×(1.9×)MA1.30×(1.2×)

The BaseRate high confidence

$123

the fair national price for a office visit, established patient (30-39 min)

typically $74–$255 across 2,070 hospitals · how we calculate it

modeled estimate · not a bill or quote

2,070

hospitals priced

states

3.4×

price spread — where shopping matters

0.9×

vs. Medicare

Across 2,070 hospitals in 52 states, a office visit, established patient (30-39 min) has a fair BaseRate of $123 and typically costs $74–$255. The cheapest state is AZ; the priciest is AK.

Cheapest hospitals for a office visit, established patient (30-39 min)

Office visit, established patient (30-39 min) cost by state

AK $252 6 hospitals AL $108 25 hospitals AR $138 36 hospitals AZ $56 29 hospitals CA $109 117 hospitals CO $128 40 hospitals CT $122 12 hospitals DE $144 8 hospitals FL $142 100 hospitals GA $119 39 hospitals HI $98 15 hospitals IA $133 76 hospitals ID $123 18 hospitals IL $129 82 hospitals IN $122 72 hospitals KS $119 76 hospitals KY $87 34 hospitals LA $79 54 hospitals MA $160 35 hospitals MD $150 4 hospitals ME $139 21 hospitals MI $105 72 hospitals MN $165 46 hospitals MO $94 38 hospitals MS $122 45 hospitals MT $131 9 hospitals NC $121 34 hospitals ND $121 12 hospitals NE $147 51 hospitals NH $132 9 hospitals NJ $123 42 hospitals NM $95 3 hospitals NV $96 16 hospitals NY $121 81 hospitals OH $114 75 hospitals OK $119 58 hospitals OR $151 23 hospitals PA $92 93 hospitals PR $100 5 hospitals RI $139 5 hospitals SC $137 33 hospitals SD $158 10 hospitals TN $82 60 hospitals TX $190 165 hospitals UT $123 28 hospitals VA $103 24 hospitals VT $122 10 hospitals WA $111 37 hospitals WI $118 64 hospitals WV $84 17 hospitals WY $128 5 hospitals

Inline Bill X-Ray & 501(r) Calculator 501(c)(3) Nonprofit · Free Care ≤200% FPL · AGB Cap 36.3%

Audit a Bill or Quote at U.S. Hospital Benchmark (Zero PHI Required)

Fair BaseRate™ $123

Medicare Rate $71

Self-Pay Cash Request Quote

Insurer Median $123

1. Amount on Your Bill or Quote ($) Pre-filled with U.S. Hospital Benchmark’s charged/list benchmark

2. Household Annual Income ($) Screened against 2026 HHS Federal Poverty Guidelines

3. Household Size (1–8) 2026 FPL: $15,650 + $5,500 per additional person

Step 1 · 501(r) Charity Care Check 501(r) AGB Cap: $107 (274% FPL)

Statutory 501(r) AGB Cap Limits Bill to $107

At 274% FPL (201%–400% FPL tier), 26 U.S.C. § 501(r)(5) caps FAP-eligible bills at Amounts Generally Billed (36.3% of gross = $107).

Step 2 · Cash vs. Insurance Arbitrage Request Prompt-Pay Quote

Compare Prompt-Pay Cash Rate Against Remaining Deductible

Ask U.S. Hospital Benchmark's billing desk for their written 45 CFR § 180 discounted self-pay cash price and Good Faith Estimate under the No Surprises Act.

Step 3 · Fair BaseRate Target +$172 Above Fair BaseRate

Negotiate Toward $123 Fair BaseRate ($71 Medicare)

Your bill ($295) is $172 above the denoised Fair BaseRate ($123) and 4.2× the $71 Medicare rate.

1-Click Factual Dispute Summary: Copy a citation-backed benchmark memo (with CMS CCN, CPT code, Medicare reference, Fair BaseRate, and 26 U.S.C. § 501(r) calculations) to paste into patient-portal messages or billing appeals.