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 | $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.
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 | $164.25 | $139.62 |
|
**Trigger Point Injection (1-2 muscles)
|
20552 | $142.50 | $121.13 |
| **Injection Large Joint | 20610 | $155.75 | $132.39 |
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 | $12.00 | $10.20 |
Procedures
| Service | Billing (CPT) Code | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| *Steroid Injection (lumbar or sacral, 1 vertebrae) | 64483 | $575.75 | $489.39 |
| *Steroid Injection (each additional vertabrae) | 64484 | $238.25 | $202.52 |
| *Injection (sacroiliac joint) | 27096 | $420.75 | $357.64 |
| *Injection (cervical or thoracic) | 62320 | $430.00 | $365.50 |
| *Diagnostic or Therapeutic Injection (lumbar or sacral, 1 vertebrae) | 64493 | $452.25 | $384.42 |
| *Diagnostic or Therapeutic Injection (each additional vertebrae) | 64494 | $222.75 | $189.34 |
| *Radiofrequency Ablation (1 joint) | 64635 | $1,108.00 | $941.80 |
| *Radiofrequency Ablation (each additional joint) | 64636 | $466.25 | $396.32 |
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 | $216.25 | $183.82 |
| ***Physical Therapy Re-evaluation (untimed code) | 97164 | $146.50 | $124.53 |
| Therapeutic Exercise, 15 minutes each | 97110 | $79.25 | $67.37 |
| Therapeutic Activities, 15 minutes each | 97530 | $104.75 | $89.04 |
| Manual Therapy Techniques, 15 minutes each | 97140 | $72.50 | $61.63 |
| Neuromuscular Re-education, 1 or more areas, 15 minutes each | 97112 | $90.00 | $76.50 |
| Self-care/Home Management, 15 minutes each | 97535 | $89.25 | $75.87 |
*Note: Most of the services in Physical 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 | $2225.75 | $189.34 |
| 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.