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.
Provider Services
Service | Billing (CPT) Code** | The Everett Clinic Self-Pay Fee | Prompt Pay Incentive 15% |
*Review of Independent Medical Exam (IME) Report
|
1063M
|
$41.09
|
N/A
|
*Impairment Rating by Consult Standard
|
1194M
|
$618.40
|
N/A
|
*Job Description Review - 1st | 1038M | $53.41 | N/A |
*Job Description Review Each additional review beyond 1st
|
1028M | $40.07 | 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 | $53.41 | N/A |
*Accident Report Completion (ROA) | 1040M | $61.63 | N/A |
*We accept the L&I payment for these services. Review this link for the Washington State L&I Fee Schedule.