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
|
$267.25 - $407.50
|
$227.17 - $346.38
|
| Office Visit Established Level 3 - Level 4 |
99213 - 99214
|
$181.25 - $266.75
|
$154.07 - $226.74
|
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
|
$76.75 | $65.24 |
|
Collection of Blood via Implanted Venous Access Device (VAD)
|
36591
|
$60.50 | $51.43 |
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
|
$26.50
|
$22.53 |
| Administration | 96372 | $61.00 | $51.85 |
|
**Neulasta (Pegfilgrastim)
Drug (1 unit used)
|
J2505 | $8,927.00 | $7,587.95 |
|
Administration
|
96372 | $61.00 | $51.85 |
|
**Bortexomib (Velcade)
Drug (typically 35 units used)
|
J9041 | $90.00 | $76.50 |
| Administration | 96401 | $227.75 | $193.59 |
|
**Lupron
Drug (typically 1 or 3 units used)
|
J9217 | $753.00 | $640.05 |
| Administration | 96402 | $97.50 | $82.88 |
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
|
$413.25 | $351.27 |
|
Chemotherapy, IV Infusion (each hour beyond first)
|
96415
|
$85.25 | $72.47 |
|
Chemotherapy, IV Infusion (billed if more than one drug infused)
|
96417 | $191.00 | $162.35 |
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
|
$173.75 | $147.69 |
|
Therapeutic IV Infusion (each hour beyond first)
|
96366
|
$50.25 | $42.72 |
|
Therapeutic IV Infusion (billed if more than one drug infused)
|
96367 | $7375 | $62.69 |
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
|
$138.25 | $117.52 |
|
Hydration IV Infusion (Each hour beyond first)
|
96361
|
$37.00 | $31.45 |
|
Hydration IV Infusion (Billed if more than one drug infused)
|
96367 | $73.75 | $62.69 |
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
|
$2.00
|
$1.70
|
|
*Ondansentron (Zofran Injection) (typically 16 units used)
|
J2405 | $0.30 | $0.26 |
|
*Ranitidine (Zantac) (typically 2 units used)
|
J2780 | $12.50 | $10.63 |
|
*Vitamin B12 (1 unit given)
|
J3420 | $9.50 | $8.08 |
|
*Iron Dextran (typically 8-30 units used)
|
J1750 | $24.00 | $20.40 |
|
*Carboplatin (typically 1-18 units used)
|
J9045 | $16.75 | $14.24 |
|
*Etoposide (typically 7-23 units used)
|
J9181 | $1.50 | $1.28 |
|
*Trastuzumab (Herceptin) (between 10-100 units used)
|
J9355 | $192.75 | $163.84 |
|
*Saline Solution Infusion (1 unit used)
|
J7030 | $8.75 | $7.44 |
|
*Bortezomib (Velcade) (between 9-10 units used)
|
J9041 | $90.00 | $76.50 |
|
*Docetaxel (typically 50-200 units used)
|
J9171 | $18.00 | $15.30 |
*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.