Constipation is a common pediatric complaint that accounts for about 5% of visits to a general pediatrician, 25% of referrals to pediatric gastroenterology, and up to 12% of all emergency department visits, leading to an estimated $3.9 billion per year of excess spending. At the Children’s Hospital of Philadelphia (CHOP) primary care clinics, between May 2016 and April 2017, a total of 12,529 patients were seen for constipation or encopresis. Of those, 398 (3%) were referred to the CHOP pediatric gastroenterology offices with a visit charge of $678 for a 60-minute new patient vs $372 at the general pediatrician’s office.