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Download the article PDF: Commercial Reimbursement In Urgent Care
While examining 17,410,492 commercially insured visits in the Experity EMR from November 1, 2024, through October 31, 2025, we calculated zero-balance net revenue per visit (NRV) for urgent care by state.
NRV represents total payments from both patients and insurers when the claim is closed, and it includes evaluation/management and ancillary codes. Data include commercial plans and third‑party managed Medicaid and Medicare but exclude self-pay, workers’ compensation, employer-paid services, motor vehicle accidents, and traditional Medicare and Medicaid visits.
With this analysis, the national median NRV was $163.91, yet there was a wide range overall from $112.90 to $299.38.
The chart groups states into quartiles. States in the bottom quartile averaged $130.30 per visit, while the top quartile averaged $221.72. Meanwhile, the lower and upper middle-quartile bands ranged from $157.87 to $181.36. This spread and a standard deviation of about 22% indicate substantial variation in commercial reimbursement.
These findings suggest there is no single national “market rate” for urgent care, but more than 50 local microeconomies. Differences likely reflect state-level payer strategies (including case rates vs fee-for-service and “any willing provider” laws), operating costs such as rent and labor, network and market saturation, and the mix of ancillary services.
