Cost of Care Estimate Cost of Care Estimate Call our dedicated estimation phone line at (859) 344-5555. To help us provide you with the most accurate price estimate, please be ready to provide as much information as possible about the specific medical services described by your physician. For surgical price estimates, you may be asked to provide us with a specific CPT Procedure code, a five-digit numerical procedure code that can be obtained from your physician. This code will help determine the procedure being performed and the estimated financial responsibility. The estimate will be based on the information provided and the most current benefits available from the insurance company. Additional charges will apply if other services are provided that are unknown at the time of the estimate. The estimate is for physician or surgeon services only and may not include all charges for incidental supplies related to the services performed. In addition, this estimate does not include any durable medical equipment, anesthesiologist, pathologist, hospital facility charges, or radiology fees. Those fees are billed separately by their respective billing companies and are not included in this estimate. It is important to note that the information provided is a good faith estimate. The final price may vary from the estimate based on the patient’s medical needs. The estimate is valid for 30 days. Indiana Urgent Care Facilities Top 15 most common Urgent Care services: Code for Service Description of Service Charge Total Units Billed self pay no discount Self pay w/30% discount IN Medicare and Managed Care Plans Non-government/In-network IN Medicaid and Managed Care Plans 87804 DETECT AGENT,IMMUN,DIR OBS,INFLUENZA $26.00 4625 $26.00 $18.20 $0.00 $16.62 $16.32 99213 OFFICE OUTPATIENT VISIT $119.00 3507 $119.00 $83.30 $86.24 $96.74 $51.99 99203 OFFICE OUTPATIENT NEW $173.00 2186 $173.00 $121.10 $105.68 $142.68 $76.71 99214 OFFICE OUTPATIENT VISIT $173.00 2110 $173.00 $121.10 $122.65 $143.16 $76.88 87880 STREP A ASSAY W/OPTIC $26.00 1825 $26.00 $18.20 $0.00 $13.76 $16.32 73630 X-RAY FOOT 3+ VW $46.00 807 $46.00 $32.20 $23.72 $31.90 $16.27 71046 RADIOLOGIC EXAM CHEST 2 VIEWS $50.00 541 $50.00 $35.00 $20.89 $24.85 $13.54 81003 URINALYSIS, AUTO, W/O SCOPE $6.00 532 $6.00 $4.20 $0.00 $2.21 $2.25 99202 OFFICE OUTPATIENT NEW $120.00 511 $120.00 $84.00 $68.46 $99.00 $52.90 S9088 SERVICES PROVIDED IN URGENT $65.00 370 $65.00 $45.50 $0.00 $27.21 $0.00 99051 MEDICAL SERVICES, EVE/WKEND/HOLIDAY $34.00 342 $34.00 $23.80 $0.00 $23.84 $0.00 96372 INJECTION,THERAP/PROPH/DIAGNOST, IM OR SUBCUT $50.00 309 $50.00 $35.00 $13.32 $31.34 $17.61 93000 ELECTROCARDIOGRAM, COMPLETE $40.00 201 $40.00 $28.00 $13.79 $26.66 $11.83 81002 URINALYSIS NONAUTO W/O SCOPE $6.00 134 $6.00 $4.20 $0.00 $3.80 $3.48 94640 PRESSURIZED/NONPRESSURIZED INHALATION TREATMENT $36.00 64 $36.00 $25.20 $12.72 $24.94 $12.80 Special Note to Indiana Patients: A patient treated at our Indiana locations may at any time ask a health care provider for an estimate of the price the health care providers and health facility will charge for providing a non-emergency medical service. Indiana law requires that the estimate be provided within five business days of the request. Call our dedicated estimation phone line at (859) 344-5555.