How much does a fractional CFO cost for a medical practice?
A fractional CFO for a medical practice usually costs a fraction of a full-time hire. On the site's own market framing, a full-time practice or health-system CFO runs $275,000 to $500,000 all-in depending on practice size, while a year of fractional CFO work runs $90,000 to $150,000, or roughly $7,500 to $12,500 a month. Most engagements are priced one of three ways: a monthly retainer, a fixed-price project or diagnostic, or hourly. At Koen Advisors the entry point is the Margin Map, a fixed $7,500 diagnostic.
01 · How pricing works
The three ways a fractional CFO is priced
Almost every fractional CFO engagement lands in one of three shapes. Which one fits depends on whether you need ongoing leadership or a defined piece of work.
- 01
Monthly retainer
The most common shape for ongoing CFO leadership. You pay a flat monthly fee for a defined scope: the reporting cadence, the cash forecast, the operating reviews, and the judgment calls in between. On the site's own market framing, a year of fractional CFO work runs $90,000 to $150,000, which is roughly $7,500 to $12,500 a month depending on how much of the seat you actually need.
- 02
Project or diagnostic
A fixed price for a defined piece of work with a start and an end: a margin review, a cash model, sale readiness, a financing package. You know the number before you start and there is no open-ended clock. Koen's Margin Map is this model. It is a fixed $7,500, runs 3 weeks, and is designed to show you what ongoing help would be worth before you commit to it.
- 03
Hourly
Some advisors bill by the hour. It can fit a narrow, one-time question, but it works against you for real CFO leadership, because the person doing the work is paid to spend more time, not to make your practice simpler. For anything ongoing, a flat retainer or a fixed-price project keeps the incentives pointed at your margin instead of the meter.
Ranges here are general market estimates and vary by practice. The only fixed, guaranteed number on this page is Koen's own: the $7,500 Margin Map.
02 · What moves the number
What drives the cost of a fractional CFO?
- 01
Scope
The single biggest lever. Monthly reporting and a cash forecast is one price. Add sale preparation, a financing raise, payer or coding analysis, or board reporting, and the seat gets wider and the fee moves with it.
- 02
Practice size and complexity
A single-site group is simpler than a multi-site group with an ASC, an OBL, and several tax entities. More locations, more service lines, and more entities mean more to reconcile and more to steer, which is why market ranges are quoted with a practice-size caveat.
- 03
State of the books
If the close is late and the numbers are not trusted, the first weeks go to cleanup before anyone can steer. Clean books lower the cost of getting started. Messy ones raise it, and are usually a sign the practice needed this help a while ago.
- 04
Whether a sale or transaction is involved
M&A, an exit, or a PE recapitalization raises the stakes and the work: quality-of-earnings support, diligence, add-back schedules, and buyer-facing reporting. Transaction-grade work sits at the higher end of any range.
03 · Fractional vs full-time
The math most owners are actually weighing
A full-time CFO is a salary, benefits, payroll taxes, and a bonus, whether or not the seat is full every week. A fractional CFO is the senior judgment you need without the fixed overhead. For a practice doing $5 to $50 million, the gap is the whole point.
These are market estimates that move with practice size, not a promise. Koen's fixed number is the Margin Map at $7,500.
- Full-time CFO, all-in
- $275,000 to $500,000
- Fractional, per year
- $90,000 to $150,000
- Fractional, per month
- $7,500 to $12,500
- Margin Map, fixed
- $7,500
04 · A way to test it first
Where the Margin Map fits
Hiring a CFO, fractional or full-time, is a real commitment. The Margin Map is the low-risk way to find out what that help is worth in your practice before you sign up for a retainer.
The entry point
A fixed $7,500, 3 weeks. It reads where your margin is leaking and what to do about it. The guarantee: it identifies at least $22,500 in margin opportunities, three times the fee, or you do not pay. Continue into a retainer and the $7,500 is credited to your first month.
Retainer capacity is capped at about 5 practices at a time, so the work stays hands-on. For a full picture of what a fractional CFO does day to day, read the guide to fractional CFOs for medical practices. To see how a CFO differs from the roles you may already have, read bookkeeper vs controller vs fractional CFO. Or see the numbers from a real engagement on the results page.
05 · Straight answers on cost
Fractional CFO cost, answered
How much does a fractional CFO cost for a medical practice?
It depends on scope and practice size, but the site's own market framing puts a year of fractional CFO work at $90,000 to $150,000, or roughly $7,500 to $12,500 a month, against $275,000 to $500,000 all-in for a full-time CFO. Koen's entry point is the Margin Map, a fixed $7,500 diagnostic, so you can see the value before committing to a retainer.
Is a fractional CFO cheaper than hiring full-time?
For most practices doing $5 to $50 million, yes. You are buying the specific hours of senior judgment you need instead of a full salary, benefits, and payroll taxes. On the site's framing a full-time CFO runs $275,000 to $500,000 all-in, while fractional runs $90,000 to $150,000 a year. The trade is availability: a fractional CFO is not sitting in your building every day.
What does the Margin Map cost, and what do I get?
The Margin Map is a fixed $7,500. It runs 3 weeks and delivers a clear read on where your margin is leaking and what to do about it. It carries a guarantee: it identifies at least $22,500 in margin opportunities, three times its fee, or you do not pay. If you continue into a retainer, the fee is credited to your first month.
Do you take a cut from PE firms, buyers, or billing vendors?
No. Koen takes no fee, commission, or referral cut from any private equity firm, buyer, or billing vendor. The only money in the engagement is what you pay for the work, so the advice you get is not quietly steering you toward someone else's payday.
Why is the price flat instead of hourly?
A flat price means the incentive is to make your practice simpler and more profitable, not to run up hours. You know the number before the work starts, and there is no meter running in the background. It keeps the focus on your margin.
What is not included in a fractional CFO engagement?
A fractional CFO is not your bookkeeper or your CPA. The bookkeeper records the transactions, the CPA files the return, and the CFO turns those numbers into decisions about cash, margin, and where the practice is headed. Good CFO work runs alongside those roles, not on top of them.
Start here
See what the seat is worth before you buy it
The Margin Map is a fixed $7,500 over 3 weeks, guaranteed to find at least $22,500 in margin opportunities or you do not pay. It is the cheapest way to find out what a CFO would do for your practice.