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.
Procedures & Tests
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| Post Void Residual Imaging | 51798 | $50.50 | $42.93 |
| Cysto (Cystourethroscopy) | 52000 | $510.25 | $433.72 |
| Cysto (Stent Removal) | 52310 | $638.00 | $542.30 |
| Prostate Biopsy (In Office) | Total: | $1,459.00 | $1,240.15 |
| Garamycin (Drug) | J1580 | $3.75 | $3.19 |
| Administration of Garamycin | 96372 | $63.25 | $53.77 |
| Needle Punch Biopsy | 55700 | $648.75 | $551.44 |
| Diagnostic Ultrasound of Prostate | 76872 | $251.00 | $213.35 |
| Ultrasound Guidance for Biopsy | 76942 | $493.50 | $419.48 |
| Vasectomy | 55250 | $1,011.25 | $859.57 |
| Adult Circumcision | 54161 | $515.00 | $437.75 |
| Irrigation of Bladder | 51700 | $209.50 | $178.08 |
Urine Analysis
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| UA Dipstick (No Microscope) | 81002 | $5.75 | $4.89 |
| Lab Urinalysis (Microscope) | 81000 | $7.25 | $6.17 |
Injectables & Treatments
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
|
**Lupron Drug
(Typically 3 units per visit)
|
J9217 | $753.00 | $640.05 |
| Administration | 96402 | $99.50 | $84.58 |
|
**BCG Drug
(Typically 50 units per visit)
|
J9030 | $5.75 ($5.75 x 50 = $287.50) | $4.89 ($244.38) |
| Administration | 51720 | $271.00 | $230.35 |
Imaging
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
|
Abdomen KUB Xray
(Kidney, Ureter, Bladder)
|
74018 | $70.50 | $59.93 |
|
CT IVP
(Hematuria Protocol)
|
74178 | $1,016.00 | $863.60 |
|
CT KUB Stone Protocol
(Urography)
|
74176 | $578.00 | $491.30 |
| Renal Ultrasound | 76770 | $359.00 | $305.15 |
* Indicates that injectable or infusion drug price is 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.