This varies from city to city, state to state, country to country. A lot of plastic surgeons do NOT charge a cosmetic consultation fee and if one is charged, it may be credited to the cost of your surgery. Some surgeons don't charge a fee altogether and others do charge a fee that is neither refundable nor can it be applied to any surgical cost. Whether or not a fee is charged is completely independent of the reputation and skill level of the surgeon. It varies between local markets, which are the main driving force in pricing, just like in any other business (restaurants, groceries, haircuts, etc.). Please remember, though, that this billing practice only applies to COSMETIC rhinoplasty consultations and not functional surgery. For functional (non-cosmetic) rhinoplasty consultations, insurance typically gets billed just like it would for any other office visits. Furthermore, if a nasal endoscopy is done at the initial consultation (which I personally always perform for rhinoplasty consultations to assess the nasal septum irrespective of the rhinoplasty being for cosmetic or functional purposes), we submit the nasal endoscopy fee to insurance. Best wishes!