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.
Procedures & Tests
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
| Post Void Residual Imaging | 51798 | $49.50 | $42.08 |
| Cysto (Cystourethroscopy) | 52000 | $507.50 | $431.38 |
| Cysto (Stent Removal) | 52310 | $603.25 | $512.77 |
| Prostate Biopsy (In Office) | Total: | $1,384.50 | $1,176.83 |
| Garamycin (Drug) | J1580 | $3.25 | $2.77 |
| Administration of Garamycin | 96372 | $63.25 | $53.77 |
| Needle Punch Biopsy | 55700 | $587.25 | $499.17 |
| Diagnostic Ultrasound of Prostate | 76872 | $237.25 | $201.67 |
| Ultrasound Guidance for Biopsy | 76942 | $493.50 | $419.48 |
| Vasectomy | 55250 | $960.00 | $816.00 |
| Adult Circumcision | 54161 | $486.25 | $413.32 |
| Irrigation of Bladder | 51700 | $206.75 | $175.74 |
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 | $97.50 | $82.88 |
|
**BCG Drug
(Typically 1 unit per visit)
|
J9031 | $276.75 | $235.24 |
| Administration | 51720 | $269.75 | $229.29 |
Imaging
| Service | Billing (CPT) Code** | The Everett Clinic Self Pay Fee | Prompt Pay Incentive 15% |
|
Abdomen KUB Xray
(Kidney, Ureter, Bladder)
|
74018 | $65.00 | $55.25 |
|
CT IVP
(Hematuria Protocol)
|
74178 | $990.00 | $841.50 |
|
CT KUB Stone Protocol
(Urography)
|
74176 | $568.25 | $483.02 |
| Renal Ultrasound | 76770 | $345.25 | $293.47 |
* 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.