Methods: Cross-sectional analysis at patient-level using Virginia All-Payer Claims Database (VA-APCD). Phy-CoC scores were calculated by averaging patient's Bice-Boxerman Index scores and weighted by the total number of visits. Patient outcomes included total cost and preventable hospitalization. Results: In a sample of 1.6 million Virginians, patients who lived in rural areas or had Medicare as primary insurance were more likely to be attributed to physicians with the highest Phy-CoC scores. Across all adult patient populations, we found that being attributed to physicians with higher Phy-CoC was associated with 7%-11.8% higher total costs, but was not associated with the odds of preventable hospitalization. Results from models with interactions revealed nuanced associations between Phy-CoC and total cost with patient's age and comorbidity, insurance payer, and the specialty of their physician. Conclusions: In this comprehensive examination of Phy-CoC using all populations from the VAAPCD, we found an overall positive association of higher full panel-based Phy-CoC with total cost, but a non-signiufb01cant association with the risk of preventable hospitalization. Achieving higher full panelbased Phy-CoC may have unintended cost implications. ( J Am Board Fam Med 2023;36:000-000.)