Physician Visits
| 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.
Office-Based Injections
| Service | Billing (CPT) Code | The Everett Clinic Self-Pay Fee | Prompt Pay Incentive 15% |
|
**Trigger Point Injection (3 or more muscles)
|
20553 | $158.50 | $134.73 |
|
**Trigger Point Injection (1-2 muscles)
|
20552 | $137.25 | $116.67 |
| **Injection Large Joint | 20610 | $147.25 | $125.17 |
Injectables (Billed Per Unit)
| Service | Billing (CPT) Code | The Everett Clinic Self-Pay Fee | Prompt Pay Incentive 15% |
|
¹Triamcinolone Acetonide (typically 4 units used)
|
J3301 | $4.00 | $3.40 |
| ¹Methylprednisone Acetate (typically 1 unit used) | J1030 | $12.50 | $10.63 |
Procedures
| Service | Billing (CPT) Code | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| *Steroid Injection (lumbar or sacral, 1 vertebrae) | 64483 | $564.25 | $479.62 |
| *Steroid Injection (each additional vertabrae) | 64484 | $221.00 | $187.85 |
| *Injection (sacroiliac joint) | 27096 | $412.25 | $350.42 |
| *Injection (cervical or thoracic) | 62320 | $400.50 | $340.43 |
| *Diagnostic or Therapuetic Injection (lumbar or sacral, 1 vertebrae) | 64493 | $443.25 | $376.77 |
| *Diagnostic or Therapuetic Injection (each additional vertebrae) | 64494 | $218.25 | $185.52 |
| *Radiofrequency Ablation (1 joint) | 64635 | $1,086.00 | $923.10 |
| *Radiofrequency Ablation (each additional joint) | 64636 | $457.00 | $388.45 |
Facility Fees
| Service | Billing (CPT) Code | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| Steroid Injection (lumbar or sacral, 1 vertebrae) | 64483.SG | $837.75 | $712.09 |
| Steroid Injection (each additional vertabrae) | 64484.SG | $326.50 | $277.53 |
| Injection (sacroiliac joint) | 27096.SG | $105.00 | $89.25 |
| Diagnostic or Therapuetic Injection (lumbar or sacral, 1 vertebrae) | 64493.SG | $865.50 | $735.68 |
| Diagnostic or Therapuetic Injection (each additional vertebrae) | 64494.SG | $323.75 | $275.19 |
| Radiofrequency Ablation (1 joint) | 64635.SG | $2,016.00 | $1,713.60 |
| Radiofrequency Ablation (each additional joint) | 64636.SG | $837.75 |
$712.09 |
Physical Therapy Services*
| Service | Billing (CPT) Code | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| ***Physical Therapy Evaluation (untimed code) | 97161-97163 | $192.25 | $163.42 |
| ***Physical Therapy Re-evaluation (untimed code) | 97164 | $130.75 | $111.14 |
| Therapeutic Exercise, 15 minutes each | 97110 | $80.50 | $68.43 |
| Therapeutic Activities, 15 minutes each | 97530 | $87.25 | $74.17 |
| Manual Therapy Techniques, 15 minutes each | 97140 | $74.75 | $63.54 |
| Neuromuscular Re-education, 1 or more areas, 15 minutes each | 97112 | $84.00 | $71.40 |
| Self-care/Home Management, 15 minutes each | 97535 | $87.75 | $74.59 |
*Note: Most of the services in Phyiscal Therapy will be time-based. A 45-minute treatment will often result in three billable codes. The codes used will depend on the type of Physical Therapy you receive.
Behavioral Health Services
| Service | Billing (CPT) Code | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| Psychotherapy, 45 minutes | 90834 | $208.50 | $177.23 |
| Psychiatric Diagnostic Evaluation | 90791 | $356.75 | $303.24 |
*Indicates that one facility fee will be billed per procedure.
**Indicates that injection code is used in conjunction with applicable drug from injectables chart.
***Indicates that these evaluation codes are often billed in conjunction with other codes listed in this section.
¹ Indicates that an injectable or infusion drug price is per unit; multiple units may be administered.