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Occupational Medicine

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.

Provider Services

 

Service Billing (CPT) Code** The Everett Clinic Self-Pay Fee Prompt Pay Incentive 15%
*Review of Independent Medical Exam (IME) Report
1063M
$42.31
N/A
*Impairment Rating by Consult Standard
1194M
$636.70
N/A
*Job Description Review - 1st 1038M $54.99 N/A
*Job Description Review Each additional review beyond 1st
 1028M $41.26 N/A
*Team Conference with Physician (Patient not present)
 99367 $167.50 $142.38

Forms (Paid by Workers Compensation Insurance)  

 

 

Service Billing (CPT) Code** The Everett Clinic Self Pay Fee Prompt Pay Incentive 15%
*APF (Activity Prescription Form)
1069M
$50.82
N/A
*Claim Reopening Application 1041M $54.99 N/A
*Accident Report Completion (ROA) 1040M $63.47 N/A

 

 

*We accept the L&I payment for these services. Review this link for the Washington State L&I Fee Schedule.

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.
Resources

What is Self-Pay?

If you are paying the bill yourself or services will not be processed by insurance.

What is Prompt Pay?

The deposit payment for your visit and any services paid by the first statement due date are eligible for a prompt pay savings incentive of 15% OFF.

Excluding cosmetic treatment and retail items.

**What is CPT?

A CPT or Billing Code is a number you can use if you want to call your insurance company to validate your out of pocket expense.

Note: Complex visits may be billed at a higher level of service and cost.

L&I Fee Schedules

Resources