Urgent care visit cost without insurance: how the visit is billed
Medicare's 2026 anchor for a new-patient urgent care visit is $119.18 at the low-complexity level (CPT 99203, Detroit, freestanding clinic), and the four new-patient levels run from $75.29 to $241.29, with a separate line for every test, X-ray or procedure added. In a hospital-owned clinic the same visit splits into a $74.70 clinician line and a $136.02 facility fee. These are Medicare anchors, not clinic prices, and no verified self-pay price exists, so the clinic's written price is the figure to get.
Prices only. Nothing here says which kind of care to seek or where. If you believe you have a medical emergency, call your local emergency number or go to the nearest emergency department, and sort out the bill afterward.
Start with the sign on the door: what the billing system calls an urgent care center
To a biller, an urgent care visit is whichever place-of-service code the claim carries. CMS publishes the code set, and four of its entries explain nearly every difference between two urgent care bills.
| Code | CMS name | What it means for the bill |
|---|---|---|
| 20 | Urgent Care Facility | A location, distinct from a hospital emergency room, an office or a clinic, that treats unscheduled, walk-in patients. The clinician is paid at the non-facility rate, which already includes the clinic's overhead. |
| 11 | Office | A physician or practice office. Same non-facility pricing as code 20. Many walk-in clinics that call themselves convenient care bill this way. |
| 19 or 22 | Off-campus or on-campus outpatient hospital | A hospital-owned clinic. The clinician is paid at the lower facility rate and the hospital bills its own facility fee on top. |
| 23 | Emergency Room, Hospital | A hospital emergency department, billed with emergency visit codes and a facility charge scaled by level. |
The descriptions are CMS's, from its place-of-service code set (page last modified February 17, 2026, read October 23, 2026). The pricing rule behind the table is in the 2026 fee schedule documentation: facility practice expense values are used for services in inpatient or outpatient hospital settings, emergency rooms, skilled nursing facilities and ambulatory surgical centers, and non-facility values are used in all other settings. A freestanding urgent care center is an "other setting." A hospital-owned one is not.
That one distinction, a freestanding center against a hospital-run one, is the biggest structural fact about an urgent care bill. The visit code is priced lower when a hospital is involved, but a second bill appears, and that second bill is larger than the amount taken off the first. The sections below show the numbers.
The visit-level code: the first line on every bill
Walk-in visits are billed with office and outpatient evaluation and management codes. New patients use 99202 through 99205, established patients use 99211 through 99215, and the five-digit code is what the clinic's price list or your itemized bill should name. CMS's file carries the level shorthand in the descriptor: 15, 30, 45 or 60 minutes for the four new-patient levels with decision making, and 10, 20, 30 or 40 minutes for established levels 2 through 5. CMS says, in its fact sheet on office and outpatient visit payment, that for levels 2 through 5 the level can rest on either the level of medical decision making or the total time the practitioner spent on the day of the visit. The level is the clinic's coding, not the patient's, so the useful question for a bill is whether the level matches the visit as you remember it.
| Code | CMS descriptor | Non-facility (freestanding clinic) | Facility (hospital-owned clinic) |
|---|---|---|---|
| 99202 | Office/outpatient new, straightforward, 15 min | $75.29 | $42.42 |
| 99203 | New, low complexity, 30 min | $119.18 | $74.70 |
| 99204 | New, moderate, 45 min | $179.97 | $121.63 |
| 99205 | New, high, 60 min | $241.29 | $167.47 |
| 99211 | Established, may not require physician | $23.98 | $7.86 |
| 99212 | Established, straightforward, 10 min | $59.64 | $32.24 |
| 99213 | Established, low, 20 min | $95.55 | $59.13 |
| 99214 | Established, moderate, 30 min | $136.48 | $87.16 |
| 99215 | Established, high, 40 min | $193.99 | $129.52 |
These are Medicare physician fee schedule amounts for CY2026 in Michigan Locality 01 (Detroit), computed from the CMS October 2026 release, using the same method as the other anchors on this site. A different locality changes them a little. They pay the clinician's side of the visit only. Checked October 23, 2026 against the national relative value file released August 26, 2026.
Look at the spread rather than any single cell. A clinic that bills the top new-patient level charges the Medicare anchor of $241.29 where a low-level visit is $119.18, a gap of $122.11 for the same front door. The lowest established code, 99211, is priced at a fraction of the others because CMS describes it as a visit that may not require a physician. That is why a bill that jumped one level above what you expected is worth a call: the arithmetic of one level is bigger than the cost of most add-ons.
The add-on layer: tests, X-rays and procedures billed beside the visit
Most urgent care bills run to two or three lines, not one. The visit-level code is joined by whatever tests, imaging or procedures were done that day, each with its own code and its own price. Medicare prices them under different systems, so the table separates the source.
| Add-on | Code | Medicare anchor | Priced under |
|---|---|---|---|
| Strep A rapid antigen test, optical | 87880 | $16.53 | Clinical lab fee schedule, Q4 2026 |
| Influenza antigen test, optical | 87804 | $16.55 | Clinical lab fee schedule |
| COVID-19 amplified probe test | 87635 | $51.31 | Clinical lab fee schedule |
| Urinalysis, automated, without microscopy | 81003 | $2.25 | Clinical lab fee schedule |
| Urine pregnancy test | 81025 | $8.61 | Clinical lab fee schedule |
| Venous blood draw | 36415 | $9.34 | Clinical lab fee schedule |
| Chest X-ray, 2 views | 71046 | $32.64 total (technical $22.48, reading $10.16) | Physician fee schedule, non-facility |
| Ankle X-ray | 73610 | $36.46 | Physician fee schedule, non-facility |
| Knee X-ray, 1 or 2 views | 73560 | $33.87 | Physician fee schedule, non-facility |
| Electrocardiogram, complete | 93000 | $15.51 | Physician fee schedule |
| Simple wound repair, 2.5 cm or less | 12001 | $115.20 non-facility; $47.84 facility | Physician fee schedule |
| Short arm splint, static | 29125 | $79.13 non-facility; $42.39 facility | Physician fee schedule |
| Therapeutic injection, subcutaneous or intramuscular | 96372 | $15.27 | Physician fee schedule |
The laboratory rates are from the CMS clinical laboratory fee schedule file for the fourth quarter of 2026. The rest are from the physician fee schedule file described above. None of these rows is a recommendation to have the test, and none implies that a visit calls for it. They are the prices attached to the codes that appear on a bill when a clinic has done them.
Three patterns recur on urgent care bills. The first is that point-of-care lab tests are small: five of the six lab and blood-draw lines above are under $17, so a stack of them rarely moves the total as much as the visit level does. The second is that imaging is priced in two parts. A chest X-ray's $32.64 is a technical component (the equipment and the technologist) of $22.48 plus a professional reading of $10.16. When a clinic sends images out for a radiologist's read, a separate bill from the radiology group can follow, which is why the guide on imaging settings treats the two components as separate layers. The third is that procedures such as wound repair or splinting are priced on the code and the setting, so the non-facility and facility figures differ by $67.36 for the simple wound repair and $36.74 for the splint in the table above.
What changes when a hospital owns the clinic
The hospital layer is the part most people do not expect. When the same visit is delivered in a hospital-owned outpatient clinic, billed under place of service 19 or 22, the hospital bills a facility fee in addition to the clinician's professional fee. Under Medicare's outpatient system the usual code for the clinic visit facility charge is G0463, "hospital outpatient clinic visit," which maps to APC 5012. The CMS October 2026 addendum (updated October 14, 2026) lists its national payment rate at $136.02 with a minimum beneficiary copayment of $27.21.
Put the two layers next to each other for a single new-patient, low-complexity visit coded 99203, without adding anything that no source published.
| Setting | Clinician (99203) | Facility fee |
|---|---|---|
| Freestanding urgent care, place of service 20 | $119.18 non-facility, covering overhead | None billed separately |
| Hospital-owned clinic, place of service 19 or 22 | $74.70 facility rate | $136.02 (G0463, national unadjusted) |
The clinician's line drops by $44.48 in the hospital setting, and a $136.02 facility line appears. The two are billed by different entities, so they arrive separately. This is the same facility-fee mechanism that the facility fees guide explains for other outpatient settings, and the reason a "same visit" can print two statements. Note, too, how the add-on tests behave. Under the hospital outpatient system, a lab test such as the strep test carries status indicator Q4, conditionally packaged, which the Medicare Claims Processing Manual (chapter 4) describes as packaged into the payment when billed on the same claim as a service with status J1, J2, S, T, V, Q1, Q2 or Q3, and otherwise paid at the clinical lab fee schedule rate. For a freestanding clinic, the $16.53 strep test is its own line. For a hospital-owned clinic billing G0463, that line can disappear into the facility payment on the Medicare claim. A self-pay price from a hospital-owned clinic is set by the hospital, and the Medicare packaging rule says nothing about it, which is why the all-in question comes first.
Where the emergency room sits on the same ruler
The emergency department is the third billing model, and the guide on urgent care against the emergency room compares the two as venues. For pricing mechanics only, here are the same two layers for emergency visit levels in the same CMS files.
| ED visit code | Clinician (facility rate) | Hospital facility payment (OPPS) | Minimum copayment on facility payment |
|---|---|---|---|
| 99281 | $11.65 | $86.15 | $17.23 |
| 99282 | $42.74 | $156.87 | $31.38 |
| 99283 | $73.73 | $278.89 | $55.78 |
| 99284 | $125.73 | $426.30 | $85.26 |
| 99285 | $181.58 | $608.43 | $121.69 |
Compare the bottom of that range with the clinic table. A level 2 emergency visit's facility payment ($156.87) is slightly above the hospital clinic's flat $136.02, and by level 3 the facility payment is more than double it. The mechanics, not the medicine, are the difference: the emergency model scales the facility charge by level, and the clinic model uses one flat charge. How the emergency levels are chosen is covered in the emergency room visit level guide.
Where the visit is matters to the Medicare anchor too
The physician fee schedule adjusts each visit code by locality, so the same code is not the same number everywhere. The new-patient low-complexity visit (99203) and the established low-complexity visit (99213) in eight Medicare localities show the spread, for a freestanding clinic (non-facility) and a hospital-owned one (facility).
| Locality | 99203 non-facility | 99203 facility | 99213 non-facility | 99213 facility |
|---|---|---|---|---|
| Arkansas | $106.69 | $67.10 | $86.86 | $54.44 |
| Alabama | $107.90 | $67.57 | $87.79 | $54.77 |
| Ohio | $112.50 | $70.42 | $90.97 | $56.51 |
| Detroit | $119.18 | $74.70 | $95.55 | $59.13 |
| Houston | $119.60 | $73.83 | $96.33 | $58.85 |
| Miami | $128.15 | $80.17 | $101.79 | $62.50 |
| Manhattan | $133.65 | $80.09 | $107.63 | $63.78 |
| San Francisco | $143.68 | $78.69 | $117.58 | $64.37 |
The non-facility amount for a low-complexity new-patient visit runs from $106.69 in Arkansas to $143.68 in San Francisco, a difference of $36.99, while the facility amount runs from $67.10 in Arkansas to $80.17 in Miami, a difference of $13.07. The non-facility amount moves more because it contains the practice-expense portion, which is the part tied to local costs and is larger when the clinic carries its own overhead. These are Medicare physician fee schedule values for CY2026, computed from the CMS October 2026 release and its geographic indexes. They are anchors for the clinician's line only; a facility fee, a test or an X-ray is a different line with a different price scale.
Testing a clinic's price list against the codes
Many clinics publish a short price menu, such as a basic visit, a visit with a test, and an add-on for stitches or an X-ray. The menu items look unlike billing codes, but each one maps to codes, and the mapping is what makes a menu comparable with the anchors on this page. The examples are invented menu lines.
| Menu line (invented) | Codes it probably stands for | Medicare anchors to hold it against |
|---|---|---|
| "Basic visit" | One new-patient or established-patient visit code, 99202 to 99205 or 99211 to 99215 | $75.29 to $241.29 for new patients; $23.98 to $193.99 for established patients (Detroit, non-facility) |
| "Visit with rapid test" | A visit code plus one test code, for example 87880 or 87804 | The visit anchor plus $16.53 or $16.55 |
| "X-ray add-on" | One imaging code, such as 71046, 73610 or 73560 | $32.64, $36.46 or $33.87 for the combined technical and reading amount |
| "Stitches" | A wound repair code, such as 12001 | $115.20 non-facility for a simple repair of 2.5 cm or less |
| "Splint" | A splint or cast application code, such as 29125 | $79.13 non-facility, plus supplies billed under their own codes |
| "Injection" | An administration code such as 96372, plus the drug under its own code | $15.27 for the administration; the drug has a separate price |
The test is not whether a menu price equals an anchor. It is whether the menu can be translated into codes at all, and whether each translated line is in a believable range. A menu line whose codes the clinic will not name, or whose total sits far above the sum of the anchors for those codes, is a line to ask about. Ask the front desk for the codes behind each menu item; a clinic that bills them can tell you.
After-hours, weekend and "urgent care global" charges
Two billing devices are specific to walk-in care. Neither is paid by Medicare, so neither has a Medicare anchor, and a clinic that uses either is following a commercial or self-pay price list.
- After-hours codes. CPT 99051 ("services provided in the office during regularly scheduled evening, weekend or holiday office hours") and 99053 (services between 10 pm and 8 am at a 24-hour facility) both carry status B in the CMS 2026 fee schedule file. CMS defines status B as a bundled code: payment is always bundled into payment for other services. A Medicare patient cannot be separately charged under those codes in the way a commercial plan's contract might allow.
- Urgent care global codes. S9083, "urgent care center global," and S9088, "services provided in an urgent care center," are listed in the same file with status I. CMS defines I as not valid for Medicare purposes, meaning Medicare uses another code for reporting and payment. They exist in the payer world so contracts can pay one flat amount per visit or add a fee for the setting.
For a patient paying cash, the useful consequence is plain. A clinic's flat visit price might be a global amount that already contains the tests, or it might be the bare visit with everything else on top. Neither is wrong. They are different products, and the clinic should say which one you are being quoted.
A worked visit with stated inputs
These inputs are invented for arithmetic only. A new patient is seen for a visit coded 99203. A strep A rapid antigen test (87880) is run. Nothing else is billed. The Medicare share is shown for each bill separately, and the two clinic types are not added together because they are alternatives, not parts of one visit.
| Line | Medicare anchor | Medicare patient share, deductible already met |
|---|---|---|
| Freestanding center: visit 99203, non-facility | $119.18 | 20% = $23.84 |
| Freestanding center: strep test 87880 | $16.53 | $0.00, lab tests carry no coinsurance for Medicare patients |
| Hospital-owned clinic: clinician 99203, facility rate | $74.70 | 20% = $14.94 |
| Hospital-owned clinic: facility fee G0463 | $136.02 | $27.21 minimum copayment (about 20%) |
| Hospital-owned clinic: strep test 87880 | Packaged into the facility payment on the Medicare claim | Not billed separately on that claim |
Medicare.gov states that you usually pay nothing for Medicare-covered diagnostic laboratory tests, and it adds that what you owe can depend on where you get the test and whether the provider accepts assignment. Medicare patients have the Part B deductible of $283 for 2026 applied first on any non-lab claim. A patient who is not on Medicare is not subject to any of these Medicare rules, which is why the table's right column does not apply to a cash price. The left column's relative shapes do: a clinician line, a facility line that exists only in one model, and small lab lines.
How to get a number before you are registered
A walk-in clinic can answer a pricing question in two minutes if it is asked the right way. The questions below are written to be read to a front desk or posted into a chat box. They are ordered by how much each one moves the final bill.
- Is this clinic owned by a hospital or health system, and will the visit be billed as a hospital outpatient visit? A yes means a facility fee is likely to be a second line.
- What is the self-pay price for a new-patient visit? What visit-level code does that price correspond to, and does the price change if the clinician codes the visit one level higher?
- Does that price include point-of-care tests and X-rays, or are they billed on top? Please list the codes and prices for the strep, flu and COVID tests, a urinalysis, and a chest, ankle or knee X-ray.
- If an X-ray is sent out for a radiologist's reading, is that a separate bill, and from whom?
- Is there an after-hours or weekend surcharge, and what is it called on the receipt?
- Is there a prompt-pay or self-pay discount, and what is the price after it?
- Can you send me this in writing, with the date and your name, before I register?
A walk-in visit is not booked ahead, so the estimate deadlines in the Good Faith Estimate guide rarely help here. The useful step is to ask the front desk for the self-pay price in writing before you register, and to confirm your price in writing before service whenever the clinic will do it. The wording for that call, including what to say about each layer, is in how to ask for the cash price.
Reading the receipt afterward
The receipt or itemized bill tells you which model you were billed under. Match each line against what you now know.
| If the bill shows | It usually means | Ask |
|---|---|---|
| One line, an E/M code from 99202 to 99215, with place of service 20 or 11 | A freestanding clinic that bills as a physician practice | Whether any test or X-ray is included in that code or billed separately |
| An E/M code plus G0463 or "facility fee" from the hospital name | A hospital-owned clinic billing two layers | Why a facility fee applies to a walk-in visit, and whether the self-pay price you were quoted included it |
| A level one step above the one you were told | The clinician coded a higher level | The documentation supporting the level, and the price at the lower level |
| A separate radiology or pathology bill | An outside group read the image or slide | Whether the clinic told you this would happen, and the group's self-pay price |
| A code starting with S, such as S9083 | A commercial or self-pay global code that Medicare does not use | What the global price includes |
Do not pay a bill you cannot match to a price you were given until the itemized statement is in hand. If it does not match, use the checking method in the itemized-bill guide. If the visit followed an ambulance ride or a transfer, the transport is a separate bill, covered in the ambulance pricing guide.
Urgent care billing FAQ
Could an extra add-on appear next to the visit code?
Yes. CMS lists G2211, a complex evaluation and management add-on, at $17.63 non-facility and $14.73 facility in Michigan Locality 01 for 2026. Whether a clinic bills it is the clinic's coding decision, and it would show as its own line under the visit code. If you see it on a bill, ask what it was billed for. It is a billing add-on to a visit, not a separate service you receive.
Do COVID and flu tests get the same treatment on a hospital-owned clinic claim?
No. In the October 2026 hospital outpatient addendum the COVID-19 amplified probe test (87635) carries status A, paid under the clinical lab fee schedule, while the optical influenza test (87804) and the strep test (87880) carry Q4, conditionally packaged. A Medicare claim from a hospital-owned clinic can therefore pay for one and fold the other into the visit payment. Outside Medicare the hospital sets how each is charged.
How much does the number of X-ray views change the price?
In the CMS 2026 file a one-view chest X-ray (71045) is $25.19 and a two-view chest X-ray (71046) is $32.64 in Michigan Locality 01, a difference of $7.45 for the second view. Ankle (73610, $36.46) and knee (73560, $33.87) films are similar in scale. Imaging is billed per code and views are part of the code, so the code on the bill tells you how many views were billed.
Can a very long visit add another code?
CMS's fact sheet on office and outpatient visits says a prolonged-service add-on, G2212, can be reported for each additional 15 minutes beyond the maximum time of the top new-patient or established-patient level when the level was chosen by time. It lists 60 to 74 minutes as the time for 99205 alone and 89 to 103 minutes for 99205 plus one G2212. The 2026 Medicare anchor for G2212 is $34.79 non-facility and $28.35 facility in Detroit. It applies only to the top levels, so it is not a feature of a routine walk-in visit.
Does my plan's allowed amount follow the facility and non-facility columns?
Not necessarily. The two columns are Medicare physician fee schedule amounts. A commercial plan's allowed amounts come from its contract with the clinic and are not published in the CMS files. What carries over is the structure: a clinician line, a facility line only in the hospital-owned model, and small add-on lines. Compare your explanation of benefits with that structure, not with the Medicare dollar figures.
Files and dates behind the anchors
CMS, Physician Fee Schedule relative value files RVU26D (October 2026 release, PPRRVU2026_Oct_nonQPP, released August 26, 2026), GPCI2026 and the RVU26D documentation, https://www.cms.gov/files/zip/rvu26d-updated-08-26-2026.zip, read October 23, 2026. CMS, Clinical Laboratory Fee Schedule CY2026 Q4 file (26CLABQ4), read October 23, 2026. CMS, OPPS October 2026 Addendum B (updated October 14, 2026), read October 23, 2026. CMS, Place of Service Code Set, https://www.cms.gov/medicare/coding-billing/place-of-service-codes/code-sets, read October 23, 2026. CMS, Know your rights when not using insurance (No Surprises Act Good Faith Estimate), read October 23, 2026. Medicare.gov, Diagnostic laboratory tests, read October 23, 2026. CMS, Physician Fee Schedule payment for office/outpatient evaluation and management visits fact sheet, https://www.cms.gov/files/document/physician-fee-schedule-pfs-payment-officeoutpatient-evaluation-and-management-em-visits-fact-sheet.pdf, read October 23, 2026. CMS, Medicare Claims Processing Manual chapter 4 (Rev. 13799, issued 05-28-26), https://www.cms.gov/regulations-and-guidance/guidance/manuals/downloads/clm104c04.pdf, status indicator Q4, read October 23, 2026. CMS 2026 Part B deductible of $283 is from the CMS 2026 premiums and deductibles fact sheet, read October 23, 2026. Medicare amounts are payment rates, not prices for patients who are not on Medicare.