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Urgent Care & Freestanding Emergency Departments · Asset Class

Urgent Care & Freestanding ED Feasibility & Market Studies

Independent, going-concern analysis for urgent care centers and freestanding emergency departments across SBA, USDA, conventional and specialty healthcare, net-lease real-estate, and health-system and platform capital. This page is our standing read on why reimbursement and payer mix, not footfall, drive value, how credentialing and ramp forecasts fail review, and the difference between the market study, the feasibility study, and the going-concern appraisal a lender requires.

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$44B
2025 US urgent care industry revenue1
14K
US urgent care centers, ~14,097 as of May 20242
10x
ED visit cost versus an urgent care visit6
90+
Days to credential a de-novo commercial payer11
The Urgent Care Thesis

One clinic, valued on reimbursement, not rent.

Urgent care is not passive real estate. It is a going-concern healthcare operating business, valued on cash flow and business-enterprise value, the real estate or leasehold plus FF&E and medical equipment plus goodwill, and its revenue engine is third-party reimbursement and payer mix, not a price the operator sets or the footfall past the door. Commercial insurers reimburse roughly 150 to 300 percent of Medicare for identical work, Medicaid pays a fraction of that, and self-pay collects less still, so the same clinical visit is worth two to four times as much in one trade area as in another.8 The trade-area payer mix, not population alone, decides viability. We prepare the market study, the feasibility study, and the going-concern appraisal input a lender needs, aligned to the standard that will judge the file.

The demand thesis is real, and so is the saturation. A hospital emergency-department visit for common, primary-care-treatable conditions averaged about ten times the cost of the same visit at an urgent care center, which is why payers underwrite diversion.6 The industry generated an estimated $44.3 billion in 2025, and center counts reached roughly 14,097, nearly double the 2014 total.123 But many metros are saturated, per-center volumes softened after COVID, with nearly 60 percent of operators reporting declining patients per day, and prominent platforms have failed, Carbon Health and GoHealth both filing Chapter 11 in 2026, while retail clinics retrenched as Walmart Health shut down in 2024.142425

One distinction governs everything downstream: urgent care and freestanding emergency departments are fundamentally different businesses and must never be conflated. A freestanding ED bills emergency facility fees, roughly ten times an urgent care visit for comparable conditions, and is subject to EMTALA; the independent, non-hospital model historically depended on out-of-network and balance billing that the No Surprises Act curtailed.22 What follows is organized as a working desk: a national demand, payer-mix, and reimbursement monitor, the credentialing and ramp failure forensics that sink de-novo studies, the capital-source routing that decides which deliverable a project needs, and the study-type distinctions competitors state loosely. Every figure is dated and attributed in the sources below.

The Demand & Payer-Mix Monitor

Where the urgent-care market stands, region by region.

A demand, saturation, and regulatory read for the major US regions, compiled from named sources. Urgent-care feasibility is driven not by population alone but by the interaction of demographics, the trade-area payer mix, competition and saturation, and the state regulatory regime. Center-per-capita data is thin and proprietary, so the reads below are directional and must be verified locally.

The national picture frames every trade area. IBISWorld sized the industry at $43.3 billion in 2024 and $44.3 billion in 2025, with profit near 14.9 percent of revenue and a highly fragmented field in which no company holds more than five percent share.1 Center counts grew from roughly 7,220 in 2014 to about 14,097 by May 2024, of which the top 100 operators run 5,675, and 39 percent of all centers carry a hospital affiliation, rising to 53 percent among the top 100.23 The Urgent Care Association tracked the count at 9,616 in November 2019 and roughly seven percent annual growth since 2018.4 Private-equity-backed centers grew to about 2,622 in the year to May 2025, roughly 18 percent of the total.5 Ownership divides into four segments: independent and physician-owned, the classic single-site SBA model that is structurally disadvantaged in payer-contract leverage; health-system-owned and joint ventures, the largest single affiliation category, often underwritten on strategic feeder value; franchised and corporate platforms; and PE-backed roll-ups chasing density and exit scale. Franchised brands offer FDD frameworks, led by American Family Care, the largest urgent care franchise, with 280 units in 28 states and an initial investment of roughly $1.23 to $1.78 million.17 Recent platform distress, alongside softening post-COVID volumes, is a caution against a software-like-economics thesis for a business with stubbornly non-software margins.1424

Supply pressure: Saturated Selective Under-served. Payer-mix and saturation reads are directional; center-per-capita data is proprietary and must be verified locally. CPOM is corporate practice of medicine; NP is nurse-practitioner scope of practice; CON is certificate of need; FSED is freestanding emergency department.
Region / market type Demand & payer-mix read Saturation Regulatory regime (CPOM / NP / CON / FSED) Supply pressure
Texas (metro) Strong commercial pockets in affluent suburbs; large uninsured share statewide High for FSEDs; heavy urgent-care competition in DFW, Houston, Austin Strong CPOM (physician ownership required); NP restricted; no general CON; licenses independent FSEDs (208 as of April 2026)21 SaturatedFSED oversupply & NSA stress; occ-med strong in energy/logistics corridors
California High commercial penetration in coastal metros; large Medi-Cal share High in coastal metros Strict CPOM (SB 351 / AB 1415 tighten MSO control from 1/1/2026); NP moving toward fuller authority; no CON29 SelectiveMSO structuring essential; regulatory cost high
Florida Older, Medicare-heavy demographic; seasonal in-migration High; mature market CPOM applies; NP full practice authority (2020+); CON largely repealed for hospitals (2019)29 SaturatedMedicare-weighted revenue per visit; retail-competitive
Northeast (NY / NJ / New England) High commercial penetration; strong occupational-medicine base High in NY and NJ metros Strong CPOM (NY); NP full-practice authority varies (NY full, others reduced); most states retain CON SelectiveHigh barriers; CON gates FSEDs and expansion
Southeast (non-FL) Mixed; non-expansion states raise the uninsured share Moderate; rising CPOM varies; SC repealed CON (2023), NC reformed (2023), TN reformed FSED CON (2025)29 SelectiveDeregulation opens entry; rural RHC angle
Mountain / Colorado Commercial-favorable in the Front Range Moderate-high; FSED-heavy Colorado licenses independent FSEDs; NP full practice; no general CON SelectiveFSED exposure; urgent-care selective
Rural (multi-state) Higher Medicare, Medicaid, and uninsured; primary-care shortage Low; under-served RHC designation available; many CON states; NP scope varies Under-servedRHC-enhanced reimbursement can make rural viable; USDA B&I fit

Regional reads compiled from the National Conference of State Legislatures (CON, updated through 2025), the American Association of Nurse Practitioners (NP scope, September 2025), Health Data Atlas and Texas HHS (FSED licensure, June 2026), and the MMCG database; see sources 12, 21, and 29. Two demographically similar trade areas can be economically incompatible purely on commercial-versus-Medicaid composition: the payer-mix geography is the revenue geography.

Charges, allowed, and collected are three different numbers

No figure on this page is more misused, or more dangerous, than revenue per visit. Gross charges are the clinic's list prices, which nobody pays in full; the allowed amount is the contracted fee-schedule rate; collected revenue is what actually lands. National median net collected revenue per commercial visit, on zero-balance claims only, was $163.91 for November 2024 through October 2025, ranging from $112.90 to $299.38 across states, from an analysis of more than 17.4 million commercially insured visits in the Experity EMR.7 Medicaid and self-pay collect far less, self-pay often 20 to 30 percent of billed charges or below, and urgent care denial rates typically run 8 to 15 percent with meaningful ancillary-revenue leakage.810 Any pro forma built on gross charges rather than net collected revenue by payer is not defensible.

The credentialing gap is the number-one de-novo failure

A de-novo center cannot bill commercial payers until each provider is credentialed and enrolled, and the two steps are distinct. Combined, they run 90 to 120 days for commercial payers and often 120 to 150 or more for new practices, 60 to 90 days for Medicare through PECOS, and up to 180 to 270 days for some state Medicaid programs.11 A provider present in the building but not yet billable generates a full fixed-cost base with no revenue, and many payers do not permit retroactive billing. One survey found 69 percent of health systems lose $1,000 to $5,000 per provider per day from enrollment delays.11 The four-to-six-month cash-flow gap this creates is the single most under-reserved item in first-time pro formas, and a defensible study sizes a working-capital reserve, typically $300,000 to $500,000 or more beyond build-out and equipment, to bridge it.15

Volume against a high fixed-cost base, with brutal seasonality

The economics are a volume game against breakeven with severe operating leverage. Breakeven is commonly cited near 25 patients per day, with successful clinics reporting breakeven between 12 and 23 PPD depending on cost structure, while the UCA reported a median of 35 PPD.13 A well-located de-novo reaches cash-flow breakeven in 12 to 18 months only if it consistently exceeds about 30 PPD at $130 to $160 net revenue per visit; months one through six are cash-flow negative.15 Recent volumes have softened, with nearly 60 percent of operators reporting declining PPD versus 2020 to 2022 and medical supplies rising from 5.4 to 15.2 percent of expenses between 2018 and 2023.14 Seasonality is extreme: respiratory season in the fourth and first quarters drives peak volume while the summer trough is severe, so annualizing peak-season volume, and failing to reserve for the trough, is a recurring modeling error. Occupational medicine, whose workers'-comp and employer business pays more reliably, is a genuine diversifier that stabilizes both seasonality and payer-mix risk.

Cap rates value the real estate, not the business

The operating business and the building are two separate valuations. Mature single-site EBITDA margins commonly run 15 to 25 percent, best-in-class above 25, and Concentra reported a 20.9 percent adjusted EBITDA margin through the third quarter of 2024.16 The going concern trades on a scale gradient, single sites at roughly 0.55 to 1.1 times revenue or about 3 times seller's discretionary earnings, multi-site groups near 3.5 times EBITDA, and premium scale or occupational-medicine platforms at 9 to 16 times EBITDA, with the Concentra and Nova Medical Centers deal at 9.4 times EBITDA the cleanest recent comparable.18 Where the real estate is owned or net-leased, it is valued separately in the medical net-lease market, where urgent care cap rates sat around 7.25 percent in 2019 and have since risen across net lease for nine or more consecutive quarters into 2024.26 Crediting a platform EBITDA multiple to a single site, or netting the business value against the real estate, overstates value.

Freestanding EDs are a separate, and structurally impaired, business

A freestanding ED bills emergency facility fees, is bound by EMTALA to screen and stabilize all comers, and requires state licensure. Two categories exist: hospital-owned satellite FSEDs, integrated with a parent hospital and Medicare- and Medicaid-billable, and independent FSEDs, which are not hospital-affiliated, not CMS-certified, and cannot bill Medicare or Medicaid.19 Only a handful of states, Texas, Colorado, Delaware, and Rhode Island, had formal independent-FSED licensing as of 2020; Texas, which legalized private for-profit freestanding emergency services in 2009, had 208 state-licensed independent standalone ERs as of April 2026, roughly 340 including hospital satellites, together handling nearly one in four ED visits statewide.21 The most rigorous national census counted about 669 FSEDs, 12 percent of all EDs, 61 percent satellite and 39 percent autonomous, though that count is now dated and has almost certainly grown.20 The No Surprises Act is the structural disruptor, and the surviving model is the hospital-affiliated one.22

Common Review Failures

How urgent care and FSED forecasts fail review.

Reimbursement, credentialing, and the patients-per-day ramp are the variables a credit committee scrutinizes most, and the places urgent care and freestanding ED studies most often break. Each failure below is tied to a real mechanism or number.

  1. The credentialing and payer-contracting gap

    The clinic opens but cannot bill commercial payers for 90 to 120 or more days, and some Medicaid programs for 180 to 270, while the pro forma assumed day-one collections. The result is a four-to-six-month cash-flow gap that first-time operators routinely under-reserve, and many payers do not allow retroactive billing. This is the number-one de-novo failure mode and a mandatory gating item.11

  2. Gross charges instead of net collected revenue

    Modeling on list prices rather than what actually lands. National median net collected revenue per commercial visit is about $164, self-pay collects a fraction of billed charges, and 8-to-15-percent denial rates plus ancillary leakage further erode collections. Using gross charges is a catastrophic and common error, and small independents overestimate the contracted rate they can negotiate against a health system or platform.710

  3. Payer mix mismatched to the trade area

    Assuming a commercial-heavy mix in a Medicaid- or uninsured-heavy trade area. Because commercial visits pay two to four times Medicaid or self-pay for identical work, the composition, not the population, is the revenue geography. A dated benchmark put the split near 67 percent commercial, 17 percent Medicare and Medicaid, and 12 percent self-pay; a trade area below roughly 50 percent commercial should trigger heightened scrutiny.9

  4. Patients-per-day ramp over-optimism and seasonality

    Assuming mature volume in year one. The ramp is 12 to 36 months, and operators commonly discover their original assumption was 30 to 40 percent too optimistic. Annualizing fourth-and-first-quarter peak volume and failing to reserve for the summer trough compounds the error; the test should be a seasonality-adjusted monthly cash-flow model, not an annualized one.1514

  5. Provider staffing and scope of practice

    Provider and staff cost is the dominant P&L line, and the physician-versus-APP model's legality is state-specific. As of 2025, 27 states plus DC grant nurse practitioners full practice authority while 12 are reduced and 11 restricted, requiring a physician collaborative or supervision agreement. Mis-modeling the mix and supervision cost, or assuming an APP-led model where it is illegal, breaks the labor line.12

  6. CPOM and MSO collateral misidentification

    In most states a non-physician may not own a medical practice, forcing a management-services-organization and friendly-professional-corporation structure. The critical trap is collateral: the lender typically lends to the MSO, whose collateral is the management contract, equipment, and real estate, not the medical practice or its payer contracts. Structuring ownership illegally in a CPOM state, or misidentifying the collateral as "the practice," is a decline-or-restructure finding.

  7. Freestanding ED modeled on the pre-NSA regime

    Modeling independent FSED economics on the out-of-network, balance-billing model the No Surprises Act curtailed as of January 1, 2022, while underestimating EMTALA cost and reputational risk. The November 2024 Amarillo closures, two freestanding EDs shut after a contracted staffing company failed to meet payroll, illustrate the operational fragility. Absent a hospital affiliation, most independent FSED underwriting should be a decline.2223

Capital-Source Routing

Which channel funds the project, and what it requires.

Urgent care routes through distinct capital sources, and each requires a different deliverable and standard. The study is built to the union of requirements across the channels actually in play, and the first questions are always whether the subject is urgent care or a freestanding ED, and whether the corporate structure and collateral are correctly identified.

The urgent-care lender matrix
Deliverable and eligibility or coverage convention by capital source. Conventions are market practice, not universal minimums.27
Capital sourceDeliverableEligibility / coverage convention
SBA 7(a) / 504 (owner-occupied)Going-concern feasibility, business valuation, and ramp working-capital sizing51% existing / 60% new owner-occupancy; 7(a) up to $5M
Conventional & specialty healthcare lendingPractice cash-flow, equipment finance, or healthcare-AR-backed facilityDSCR ~1.25x+; AR advance keyed to the payer cycle
USDA B&I (rural)Owner-operated business feasibility with RHC reimbursement analysisGuarantee by loan size; RHC all-inclusive rate $165 (2026)
MOB / net-lease real estateIncome-approach appraisal on the site, separate from the businessNet-lease medical cap rates ~7%+, rising into 2024
Health-system / PE / platform capitalStrategic feeder or platform (EBITDA-multiple) underwritingValuation graded by scale, not a standalone multiple

Sources: SBA SOP 50 10 8; USDA Rural Development and the Rural Health Information Hub; The Boulder Group net-lease medical data; Scope Research and CT Acquisitions valuation ranges. See sources 18, 26, 27, and 28.

One eligibility trap is worth stating plainly, because it is structural rather than about passive investment: corporate practice of medicine. In most states a non-physician may not own a medical practice, so the SBA borrower must be an eligible operating entity, and a friendly-professional-corporation structure requires careful eligibility analysis.27 Critically, the lender is typically lending to the management-services organization, whose collateral is the management contract, equipment, and real estate, not the medical practice or its payer contracts. A second gate is the freestanding ED question: an independent, non-hospital-affiliated FSED, whose out-of-network model the No Surprises Act curtailed, should usually be a decline absent a hospital affiliation or a demonstrated in-network contract base.22 And in rural markets a Rural Health Clinic designation, which pays an all-inclusive rate per visit, can make a clinic viable where a standard urgent care would not be.28

  • De-novo owner-occupied urgent careSBA 7(a) or 504 with a going-concern feasibility and a working-capital reserve bridging credentialing plus the ramp.
  • Acquisition of a credentialed, ramped centerSBA change-of-ownership requiring a business valuation and a going-concern appraisal.
  • Rural owner-operated clinic in a shortage areaUSDA Business & Industry, with RHC designation to unlock the all-inclusive per-visit rate.28
  • Owned or net-leased real estateMOB or net-lease real-estate financing, valued separately from the operating business.26
  • Independent freestanding ED without hospital affiliationGenerally a decline post-No Surprises Act; restructure toward a hospital-affiliated HOPD model.
Study Types

Market study, feasibility study, appraisal: three questions.

These three documents answer different questions and are not substitutes. Lenders and sponsors conflate them constantly; underwriters and credit committees do not.

What each document answers, and the standard or basis that governs it.
DocumentQuestion answeredGoverning standard
AppraisalWhat is it worth? A going-concern business-enterprise value, real estate or leasehold plus FF&E and medical equipment plus goodwill, via the income approach on an EBITDA or SDE multiple.USPAP; business-enterprise valuation
Market studyIs there demand? Trade-area demographics, payer mix, competition, and saturation.Trade-area demand & payer-mix analysis
Feasibility studyDoes this project pencil? Ramp, breakeven PPD, credentialing and working capital, seasonality, and DSCR.Lender underwriting + going-concern income approach

The distinction that governs an urgent care file is that it is valued as a going-concern healthcare operating business, not as passive real estate. The appraisal allocates value among the real property, the equipment, and the intangibles, payer contracts, patient base, and provider relationships. The key technical question is the subject entity: in a corporate-practice-of-medicine state, the business being valued and financed is typically the management-services organization, not the professional corporation that holds the medical license and the payer contracts. The MSO holds the management contract, equipment, and often the real estate or lease; a friendly-PC structure means the lender is generally not lending against the payer contracts or the practice itself. Where the real estate is owned or net-leased, it is valued separately as retail or medical-office real estate.

One scope boundary is worth stating. Urgent care is relatively low environmental risk, but medical-waste handling, x-ray and radiology shielding, and prior-site-use considerations mean a Phase I Environmental Site Assessment is standard; the feasibility or market-study author does not itself perform the Phase I or II ESA, which is a separate environmental professional's engagement. The market and feasibility work verifies the payer mix, models net collected revenue, stresses the ramp and breakeven, and sizes the working-capital reserve; it does not opine on environmental condition.

Urgent care sub-segments, each with a distinct study scope

Urgent Care Questions

Urgent care feasibility and market-study questions.

What is the difference between an urgent care market study and a feasibility study?

A market study assesses trade-area demand, the payer mix, and competition or saturation, and answers whether there is a viable patient and revenue base. A feasibility study goes further, testing whether a specific center can reach cash-flow breakeven and cover its debt under conservative assumptions, including the credentialing and enrollment timeline, the patients-per-day ramp, working-capital reserve, seasonality, and debt-service coverage. Because urgent care is a going-concern healthcare operating business, the feasibility study models net collected revenue by payer, not gross charges, and stresses the ramp well below the operator's own assumption.

Is an urgent care center valued as a business or as real estate?

As a going-concern business. Urgent care is valued on cash flow and business-enterprise value, meaning the real estate or leasehold plus FF&E and medical equipment plus intangible goodwill such as payer contracts, patient base, and provider relationships, capitalized through the income approach on an EBITDA or SDE multiple. Single-site centers trade at roughly 0.55 to 1.1x revenue or about 3x seller's discretionary earnings, multi-site groups near 3.5x EBITDA, and premium scale or occupational-medicine platforms at 9 to 16x EBITDA. Where the real estate is owned or net-leased, it is valued separately as retail or medical-office real estate at a net-lease cap rate.

Can an urgent care center be financed with an SBA loan?

Yes, urgent care is a common SBA use. SBA 7(a), up to $5 million, funds the business, build-out, equipment, and working capital, while 504 funds owner-occupied real estate at 51 percent occupancy for existing buildings and 60 percent for new construction under SOP 50 10 8. The complication is corporate practice of medicine: in most states a non-physician may not own a medical practice, so the borrower is typically a management-services organization tied to a friendly professional corporation, and eligibility must be analyzed carefully. The lender's collateral in that structure is the management contract, equipment, and real estate, not the medical practice or its payer contracts. SBA working-capital sizing for the credentialing and ramp period is the item most often inadequate.

What is the credentialing gap, and why does it sink de-novo pro formas?

A de-novo center cannot bill commercial payers until each provider is credentialed and enrolled, which routinely takes 90 to 120 days for commercial payers and often 120 to 150 or more for new practices, 60 to 90 days for Medicare through PECOS, and up to 180 to 270 days for some Medicaid programs. During that window the clinic incurs a full fixed-cost base with little or no collectible revenue, and many payers do not permit retroactive billing. One survey found 69 percent of health systems lose $1,000 to $5,000 per provider per day from enrollment delays. This four-to-six-month cash-flow gap is the single most under-reserved item in first-time pro formas, and a feasibility study should require a working-capital reserve, typically $300,000 to $500,000 or more beyond build-out and equipment, sized to bridge it.

How are urgent care centers and freestanding emergency departments different?

They are fundamentally different businesses and must never be benchmarked against each other. An urgent care center bills office and clinic evaluation-and-management fees, while a freestanding emergency department bills emergency facility fees, roughly 10x an urgent care visit for comparable conditions, and is subject to EMTALA screen-and-stabilize obligations and state licensure. Freestanding EDs come in two forms: hospital-owned satellite EDs that are integrated with a parent hospital and can bill Medicare and Medicaid, and independent EDs that are not hospital-affiliated, not CMS-certified, and cannot bill Medicare or Medicaid. Their P&Ls, regulatory exposure, and risk profiles do not translate to urgent care.

How has the No Surprises Act affected freestanding ED underwriting?

The No Surprises Act, effective January 1, 2022, bans balance billing for out-of-network emergency and post-stabilization care and routes payment disputes through an Independent Dispute Resolution process keyed to the Qualifying Payment Amount. The independent freestanding ED model historically depended on out-of-network and balance billing, so the Act structurally impaired it. Some operators now pursue inflated IDR claims, prompting state responses, and staffing fragility has produced abrupt closures, such as two Amarillo freestanding EDs shut in November 2024 after a contracted staffing company failed to meet payroll. Absent a hospital affiliation or a demonstrated in-network contract base, most independent freestanding ED underwriting should be treated as a likely decline.

What net revenue per visit and patients per day should an urgent care pro forma assume?

Use net collected revenue, not gross charges. National median net revenue per commercial visit was about $164 for November 2024 through October 2025, with a state range of roughly $113 to $299, and Medicaid and self-pay collect far less. Breakeven runs roughly 25 to 30 patients per day and mature centers reach the mid-30s. A well-located de-novo reaches cash-flow breakeven in 12 to 18 months only if it consistently exceeds about 30 patients per day, and the ramp should be stressed 30 to 40 percent slower than the operator's assumption on a seasonality-adjusted monthly basis, because respiratory season drives peak volume and the summer trough is severe.

By Market

Urgent care feasibility studies by state.

Urgent care demand, the payer mix, and the regulatory regime are local. Explore the state markets where trade-area commercial penetration, saturation, and the CPOM, scope-of-practice, CON, and FSED-licensure layers determine whether a center pencils.

Underwriting an urgent care or freestanding ED? Start with the payer mix.

Feasibility Study Company prepares independent Urgent Care & Freestanding ED feasibility and market studies, built to the review standard your capital source applies. A methodology briefing walks through the analytical framework, the deliverable your capital source requires, and the current demand, payer-mix, credentialing, and reimbursement data for your trade area and model.

Request a methodology briefing
Sources

Data sources and dates.

Every figure on this page traces to a named authority. Healthcare readings are point-in-time and provider-dependent; center counts, market size, and revenue per visit differ by basis, and the charges-versus-allowed-versus-collected distinction is flagged throughout. Metrics are not comparable across incompatible bases.

  1. IBISWorld, “Urgent Care Centers in the US” (2025): industry revenue of $43.3 billion in 2024 (up 3.1%) and $44.3 billion in 2025, profit near 14.9% of revenue, no company above 5% share, and the “number of businesses” metric (5,599 operators, 2024) that counts enterprises, not centers.
  2. Journal of Urgent Care Medicine, “2024 Urgent Care's Top 100” (May 2024), National Urgent Care Realty / Experity data: roughly 14,097 centers as of May 2024; the top 100 operators run 5,675 (38%); 39% of all centers hospital-affiliated, rising to 53% among the top 100.
  3. Trilliant Health via Grand View Research (May 2024): 14,382 centers in 2023, up from ~7,220 in 2014 (a 99.2% increase); Grand View Research market size of $36.4 billion for 2025 (a broader/differing definition, flagged as a basis difference).
  4. Urgent Care Association counts: 9,616 centers reported in November 2019 and roughly 7% annual growth tracked since 2018.
  5. Journal of Urgent Care Medicine, “Private Equity Investment in Urgent Care,” Alan Ayers (May 2025): PE-backed centers grew from 2,359 to 2,622 in the 12 months to May 2025, about 18% of all US urgent care.
  6. UnitedHealth Group, “18 Million Avoidable Hospital Emergency Department Visits” (July 2019, using 2018 data): a hospital ED visit averaged $2,032 versus $193 at urgent care (10x) and $167 at a physician office (12x); UnitedHealthcare consumer figures (2023) put the median ER visit at $1,700 versus $165 at urgent care.
  7. Journal of Urgent Care Medicine, “Commercial Reimbursement in Urgent Care” (Experity EMR analysis of 17,410,492 commercially insured visits): national median net revenue per commercial visit of $163.91 for November 2024–October 2025, ranging $112.90–$299.38 by state (bottom quartile $130.30, top quartile $221.72); prior Experity data showed NRV near $132 at year-end 2023 and ~$123 for 2013–2016. Collected revenue on commercial claims only.
  8. Vizient and PayerPrice (2025–2026): commercial reimbursement roughly 150–300% of Medicare (~230% on average); Medicaid roughly 50–70% of Medicare (~72% national average); self-pay collections 20–30% of billed charges or less; producing a 2–4x revenue-per-visit spread by payer for identical work.
  9. UCAOA 2017 Benchmarking Survey (the most recent comprehensive published payer-mix split, now dated): roughly 67% commercial, 17% Medicare and Medicaid combined, and 12% cash/self-pay; CT Acquisitions (2026) analyst target mix of commercial above 50%, Medicare 15–25%, Medicaid below 25%, and no single payer above 20% of revenue.
  10. Qualigenix (2026): urgent care denial rates typically 8–15% and centers commonly losing 15–25% of ancillary revenue to unbilled services, underscoring revenue-cycle management as a core competency.
  11. Medallion, 2026 State of Payer Enrollment (via Hospitalogy, May 2026): 69% of health systems lose $1,000–$5,000 per provider per day from enrollment delays. Credentialing and enrollment timelines (NGA Healthcare; Medwave; RCMAXIS; TrueCare RCM, 2026): 90–120 days commercial and 120–150+ for new practices, 60–90 days Medicare (PECOS), and up to 180–270 days for some Medicaid programs; many payers disallow retroactive billing.
  12. American Association of Nurse Practitioners (September 2025): 27 states plus DC (and two US territories) grant nurse practitioners full practice authority; 12 states are reduced-practice and 11 restricted-practice, requiring a physician collaborative or supervision agreement.
  13. Experity: breakeven commonly cited near 25 visits/day, with a seven-day rolling average of ~25 visits/clinic/day in mid-June 2024 (about 3% below the prior year); ProfitableVenture: breakeven between 12 and 23 PPD depending on cost structure; Urgent Care Association (2018 report, 2017 data): median 35 PPD.
  14. Urgent Care Association 2023 Finance Benchmarking Report: nearly 60% of respondents reported declining PPD versus 2020–2022; medical supplies rose from 5.4% of expenses in 2018 to 15.2% in 2023.
  15. Urgent Care Consultants (2026): a well-located de-novo reaches cash-flow breakeven in 12–18 months only above ~30 PPD at $130–$160 NRV; build-out ~$600,000+ for a 3,000–4,000 sq ft center (plus $25,000–$50,000 x-ray shielding), total capital $1.4 million+, and a working-capital reserve of $300,000–$500,000+ beyond build-out and equipment; ramp assumptions commonly 30–40% too optimistic.
  16. LBMC and FOCUS Investment Banking (2025): mature single-site EBITDA margins of 15–25% (best-in-class above 25%; financial-model benchmarks 12–18%); Concentra Q3 2024 release: 20.9% adjusted EBITDA margin YTD Q3 2024.
  17. American Family Care FDD 2024 (via FranchiseGrade / Franchisepayback and the AFC franchising site): the largest urgent care franchise, founded 1982, 280 franchised units in 28 states, initial investment $1,227,774–$1,778,851 including a $60,000 franchise fee, 6% royalty, and 10-year term; secondary FDD summaries cite ~$2 million average gross revenue per unit (verify against the current FDD; Item 19 is a franchisor-selected representation).
  18. Scope Research (2025): single-site centers ~0.55–1.1x revenue or ~3x SDE; multi-site groups ~3.5x EBITDA; premium scale/occ-med platforms 9–16x EBITDA; announced urgent-care M&A deals down from 44 (2021) to 27 (2024). CT Acquisitions citing FOCUS Investment Banking (April 2025) and the Concentra/Nova Medical Centers deal (9.4x EBITDA / 2.0x revenue).
  19. Health Affairs Scholar (2025), Ho et al.: FSED categories (hospital-owned satellite vs independent); the 20 most common FSED diagnoses mirror urgent care but at ~10x the cost; FSED openings associated with increased spending and medical debt.
  20. NEDI-USA / Western Journal of Emergency Medicine (Camargo et al., 2020, using 2017 data): ~669 FSEDs, 12% of all EDs, 61% satellite / 39% autonomous, Texas 373; an alternative peer-reviewed count of 360 (Annals of Emergency Medicine, 2017). Both are now dated and the count has almost certainly grown.
  21. Health Data Atlas via Texas HHS (June 2026): 208 state-licensed independent standalone ERs in Texas as of April 2026 (~340 including hospital-owned satellites), together handling nearly one in four ED visits statewide; four states with formal independent-FSED licensing as of 2020 (Texas, Colorado, Delaware, Rhode Island); Texas legalized private for-profit freestanding emergency services in 2009; Idaho's early-2026 balance-billing response and the Nutex IDR example ($3,187 sought for a UTI against a $521 going rate).
  22. No Surprises Act, effective January 1, 2022 (ACEP; U.S. Department of Labor, 2022–2024): ban on out-of-network balance billing for emergency and post-stabilization care, in-network cost-sharing limits, and an Independent Dispute Resolution process keyed to the Qualifying Payment Amount, which curtailed the independent FSED out-of-network model.
  23. Becker's Hospital Review / KFDA NewsChannel 10 (November 2024): Northwest Texas Healthcare System abruptly closed two freestanding EDs in Amarillo after its contracted physician-staffing company (NES Health) failed to meet payroll.
  24. Bloomberg Law, Law360, and ElevenFlo (2026): Carbon Health Technologies Chapter 11 (February 2, 2026), roughly $99.3 million of funded debt led by a $77 million first-lien term loan (Future Solution Investments LLC), a $19.5 million initial DIP plus $11 million approved May 8, 2026, emerging June 15, 2026 under lender ownership after raising more than $600 million; S&P Global and TheStreet (2026): GoHealth Chapter 11 (June 7, 2026), ~$917 million assets / $986 million debts.
  25. Health Affairs (2021), “Urgent Care Centers Deter Some Emergency Department Visits But, On Net, Increase Spending”; NBER (diminishing marginal impact as markets mature); Health Services Research, Allen et al. (2021), urgent care open hours reduced nearby ED low-acuity visits, largest among Medicaid and uninsured; FAIR Health, urgent care commercial-claim utilization up 207% from 2013 to 2022; Walmart Health closure (2024) and CVS MinuteClinic closures. The ED-diversion cost-savings thesis is genuinely contested.
  26. The Boulder Group, Net Lease Medical Report and 2024 releases: urgent care net-lease cap rates around 7.25% in 2019 (a 5 bps decline that year) within a net-lease medical sector then near 6.45%, with cap rates rising across net lease for nine-plus consecutive quarters into 2024; a recently built, corporate-guaranteed Fast Pace Health urgent care in La Porte, Indiana (2023 construction, ~13-year lease, 10% escalations every 5 years) traded to a 1031-exchange buyer.
  27. U.S. Small Business Administration, SOP 50 10 8 (the current origination policy, succeeding SOP 50 10 7.1 effective November 15, 2023): 7(a) up to $5 million for business, build-out, equipment, and working capital; 504 for owner-occupied real estate at 51% (existing) / 60% (new construction); the CPOM / friendly-PC eligibility question and the change-of-ownership business-valuation and going-concern-appraisal requirement.
  28. USDA Rural Development, Business & Industry (B&I) Guaranteed Loan Program, and the Rural Health Clinic all-inclusive rate capped at $152 in 2025 and $165 in 2026 for independent and larger provider-based RHCs (Azalea Health citing CMS; Rural Health Information Hub, 2025–2026); RHC status requires a rural shortage-area (HPSA/MUA) location and at least one NP, PA, or CNM on site 50% of operating hours; FQHC designation offers a separate enhanced-reimbursement pathway.
  29. National Conference of State Legislatures (updated through 2025): certificate-of-need programs active in 35 states plus DC; California SB 351 / AB 1415 MSO restrictions effective January 1, 2026; Florida CON largely repealed for hospitals (2019) and NP full practice authority (2020+); South Carolina repealed CON (2023), North Carolina reformed CON (2023), and Tennessee reformed FSED CON (2025).