Obstetrics and gynecology Provider 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 $288.75 - $437.25 $245.44 - $371.66

Office Visit Established

Level 3 - Level 4 99213 - 99214 $213.75 - $302.50 $181.69 - $257.13

Established Patient Preventive Visit (Age-Based)

99394 - 99397 $312.75 - $366.50 $265.84 - $311.53

New Patient Preventive Visit (Age-Based)

99384 - 99387 $366.50 - $446.00 $311.53- $379.10

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

Deliveries

Service Billing (CPT)

Code** The Everett Clinic Self

Pay Fee Prompt Pay

Incentive 15%

¹Full Routine Obstetric Care Vaginal Delivery

59400 $5,766.75 $4,901.74

¹Full Routine Obstetric Care Cesarean Delivery

59510 $6,375.75 $5,419.39

¹Cesarean Delivery Only 59514 $2,442.50 $2,076.13

¹Obstetric Care Vaginal Delivery & Postpartum

59410 $2,797.75 $2,378.09

Antepartum Care Only Greater than 7 Visits

59426 $2,349.75 $1,997.29

Antepartum Care Only 4-6 Visits 59425 $1,283.75 $1,091.19

Imaging

Service Billing (CPT)

Code** The Everett Clinic

Self-Pay Fee Prompt Pay

Incentive 15%

Obstetric Ultrasound, Transvaginal (During Office Visit)

76817 $268.25 $228.01

Note: Pricing for ultrasounds scheduled in the imaging dept. can be found on the Advanced Imaging page.

Tests & Procedures

Service Billing (CPT)

Code** The Everett Clinic

Self Pay Fee Prompt Pay

Incentive 15%

Fetal Non-Stress Test 59025 $132.50 $112.63

IUD (Intrauterine Device) Removal 58301 $281.50 $239.28

Colposcopy

Procedure 57454 $450.25 $382.71

Pathology - 1 Charge per specimen

(Typically 2-4 specimens/procedure)

88305 (PH002)

$211.25 $179.56

Circumcision

Clamp method, Newborn - 28 days 54150 $426.75 $362.74

Biopsy of Uterus Lining

Procedure 58100 $284.50 $241.83

Pathology - 1 Charge per specimen (Typically 1 specimens/procedure)

88305 (PH002)

$211.25 $179.56

Supply - Endometrial Suction Curette (SA248) A4649 $9.25 $7.87

Vaginal Wet Mount/Smear Consists of 4 Total: $42.50 $36.13

Smear with Interpretation 87210 $12.25 $10.42

Tissue Examination 87220 $9.75 $8.29

pH of Body Fluid 83986 $7.75 $6.59

Qualitative Amines Test 82120 $12.75 $10.84

Injections

Service Billing (CPT)

Code** The Everett Clinic

Self Pay Fee Prompt Pay

Incentive 15%

*Medroxyprogesterone Acetate (DepoProvera Shot)

Drug (150 units used)

J1050 $2.00 per unit $1.70 per unit

Administration 96372 $61.25 $52.06

Total: $361.25 $307.06

TDAP Vaccine

Drug 90715 $75.25 $37.63

Administration 90471 $63.25 $31.63

Total: $138.50 $69.26

RHO (D) Immune Globulin J2790 $166.00 $141.10

Drug

Administration 96372 $61.25 $52.06

Total: $227.25 $193.16

*Indicates that injectable or infusion drug price is per unit; multiple units may be administered.

¹Indicates that a facility fee will be billed by Providence in addition to The Everett Clinic charge, the patient should ask Providence for a quote.

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.