Provider Visit & Services
| Service | Billing (CPT) Code** | The Everett Clinic Self-Pay Fee | Prompt Pay Incentive 15% |
| Office Visit New Patient Level 3 - Level 4 |
99203 - 99204
|
$276.50 - $421.25
|
$235.03 - $358.07
|
| Office Visit Established Level 3 - Level 4 |
99213 - 99214
|
$187.00 - $276.00
|
$158.95 - $234.60
|
Note: Complex visits may be billed at a higher level of service and cost.
Services
| Service | Billing (CPT) Code¹ | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| IV Port Flush |
96523
|
$78.50 | $66.73 |
|
Collection of Blood via Implanted Venous Access Device (VAD)
|
36591
|
$62.25 | $52.92 |
Injectable Treatments
| Service | Billing (CPT) Code¹ | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
|
**Epoetin Alfa (Procrit)
Drug (typically 10-60 units used)
|
J0885
|
$27.50
|
$23.38 |
| Administration | 96372 | $63.25 | $53.77 |
|
**Neulasta (Pegfilgrastim)
Drug (1 unit used)
|
J2505 | $10,285.00 | $8,742.25 |
|
Administration
|
96372 | $63.25 | $53.77 |
|
**Bortexomib (Velcade)
Drug (typically 35 units used)
|
J9041 | $88.50 | $75.23 |
| Administration | 96401 | $232.25 | $197.42 |
|
**Lupron
Drug (typically 1 or 3 units used)
|
J9217 | $753.00 | $640.05 |
| Administration | 96402 | $99.50 | $84.58 |
Chemotherapy Infusion Services
Chemotherapy Infusions consist of 96413, 96415 and or 96417 if applicable and the appropriate drug code.
| Service | Billing (CPT) Code¹ | The Everett Clini Self-Pay Fee | Prompt Pay Incentive 15% |
|
Chemotherapy, IV Infusion (1 hour)
|
96413
|
$421.50 | $358.28 |
|
Chemotherapy, IV Infusion (each hour beyond first)
|
96415
|
$87.00 | $73.95 |
|
Chemotherapy, IV Infusion (billed if more than one drug infused)
|
96417 | $194.75 | $165.54 |
Therapeutic Infusion Services
Chemotherapy Infusions consist of 96413, 96415 and or 96417 if applicable and the appropriate drug code.
| Service | Billing (CPT) Code** | The Everett Clinic Self-Pay Fee | Prompt Pay Incentive 15% |
| Therapeutic IV Infusion (1 hour) |
96365
|
$188.25 | $160.02 |
|
Therapeutic IV Infusion (each hour beyond first)
|
96366
|
$56.50 | $48.03 |
|
Therapeutic IV Infusion (billed if more than one drug infused)
|
96367 | $81.25 | $69.07 |
Hydration Infusion Services
Chemotherapy Infusions consist of 96413, 96415 and or 96417 if applicable and the appropriate drug code.
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| Hydration IV Infusion (1 Hour) |
96360
|
$140.50 | $119.43 |
|
Hydration IV Infusion (Each hour beyond first)
|
96361
|
$37.50 | $31.88 |
|
Hydration IV Infusion (Billed if more than one drug infused)
|
96367 | $81.25 | $69.07 |
Infusibles
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
|
*Dexamethasone (typically 12 units used)
|
J1100
|
$.50
|
$.43
|
|
*Diphenhydramine (Benadryl) (1 unit used)
|
J1200
|
$2.75
|
$2.34
|
|
*Ondansentron (Zofran Injection) (typically 16 units used)
|
J2405 | $0.32 | $0.27 |
|
*Ranitidine (Zantac) (typically 2 units used)
|
J2780 | $10.75 | $9.14 |
|
*Vitamin B12 (1 unit given)
|
J3420 | $7.25 | $6.17 |
|
*Iron Dextran (typically 8-30 units used)
|
J1750 | $26.50 | $22.53 |
|
*Carboplatin (typically 1-18 units used)
|
J9045 | $14.00 | $11.90 |
|
*Etoposide (typically 7-23 units used)
|
J9181 | $1.50 | $1.28 |
|
*Trastuzumab (Herceptin) (between 10-100 units used)
|
J9355 | $208.75 | $177.44 |
|
*Saline Solution Infusion (1 unit used)
|
J7030 | $8.25 | $7.02 |
|
*Bortezomib (Velcade) (between 9-10 units used)
|
J9041 | $88.50 | $75.23 |
|
*Docetaxel (typically 50-200 units used)
|
J9171 | $6.00 | $5.10 |
*Indicates that injection code is used in conjunction with the applicable drug from injectables chart.
**Indicates that injectable or infusion drug is priced per unit; multiple units may be administered.
Disclaimer: While The Everett Clinic strives to give you accurate information regarding prices and estimated costs, several factors may affect pricing, including, but not limited to: (1) Time of selection: Prices are subject to change at any time. (2) Additional expenses: Beyond what's defined, some laboratory and professional fees, such as a physician, radiologist, anesthesiologist, and pathologist, may not be included in this estimate. (3) Additional services: Your health condition may require additional time with the same practitioner, specialist or a different condition than scheduled.