Ear, nose and throat Physician Visits Billing (CPT) The Everett Clinic Prompt Pay Service Code** Self Pay Fee Incentive 15% Office Visit New Patient Level 99203 - 99204 $282.25 - $430.00 $239.92 - $365.50 3 - Level 4 Office Visit Established Level 99213 - 99214 $195.75 - $282.75 $166.39 - $240.34 3 - Level 4 Note: Complex visits may be billed at a higher level of service and cost.

Procedures & Tests Billing (CPT) The Everett Clinic Prompt Pay Service Code** Self Pay Fee Incentive 15% Ear Cleaning 69210 $125.75 $106.89 ENG - Electronystagmography 92540 $313.00 $266.05 Basic Vestibular Evaluation Laryngoscopy (Throat Scoping) 31575 $337.50 $286.88 Nasal Scoping (Biopsy, Removal Polyp, 31237 $795.50 $676.18 Debridement) Nasopharyngoscopy 92511 $340.75 $289.64 (Nasopharynx only) Nasopharyngoscopy (Total Nasal 31231 $557.00 $473.45 Cavity) Flexible Laryngoscopy Panel 31575 $337.50 $268.88 Otomicroscop 92504 $87.75 $74.59

Audiology Visits

Billing The Everett Prompt Pay Service (CPT) Clinic Self-Pay Incentive 15% Code** Fee Comprehensive Hearing Test 92557 $110.25 $93.72 Conditioning Play Audiometry 92582 $227.25 $193.17 Ear Exam (Ear Microscopy) 92504 $87.75 $74.59 Tympanometry (Mobility of Eardrum) 92567 $46.75 $39.74 Visual Audiometry (VRA) 92579 $135.25 $114.97 Myringotomy - Unilateral 69420 $514.00 $436.90 Myringotomy - Bilateral 69420-50 $771.00 $655.35 PE Tube (Tympanostomy) local or topical 69433 $542.25 $460.92 anesthesia, Unilateral PE Tube (Tympanostomy) local or topical 69433-50 $813.38 $691.38 anesthesia, Bilateral PE Tubes (Tympanostomy) general anesthesia 69436 $420.25 $357.22 - Unilateral PE Tubes (Tympanostomy) general anesthesia 69436-50 $630.38 $535.83 - Bilateral Tonsillectomy, primary or secondary; younger 42825 $703.50 $597.98 than age 12 Tonsillectomy, primary or secondary; age 12 42826 $672.00 $571.20 or over Adenoidectomy, primary, younger than age 12 42830 $558.50 $474.73 Tonsillectomy and adenoidectomy; younger 42820 $767.25 $652.17 than age 12 Septoplasty 30520 $1,750.00 $1,487.50 Submucous resection inferior turbinate 30140 $1,159.50 $985.58 Submucous resection inferior turbinate 30140-50 $1,739.25 $1,478.37 bilateral Fracture nasal inferior turbinate(s), therapeutic 30930 $322.25 $273.92 Fracture nasal inferior turbinate(s), therapeutic 30930-50 $483.38 $410.88 bilateral Nasal/sinus endoscopy, surgical w/maxillary 31256 $510.50 $433.93 antrostomy Nasal/Sinus endoscopy, surgical w/maxillary 31256-50 $765.75 $650.89 antrostomy bilateral Nasal/sinus endoscopy, surgical; 31255 $1,029.75 $875.29 w/ethmoidectomy, total Nasal/sinus endoscopy, surgical; 31255-50 $1,544.63 $1,312.94 w/ethmoidectomy, total bilateral Nasal/sinus endoscopy, surgical; w/frontal 31276 $1,298.75 $1,103.94 sinus exploration Nasal/sinus endoscopy, surgical; w/frontal 31276-50 $1,948.13 $1,655.92 sinus exploration bilateral Nasal/sinus endoscopy, surgical; 31287 $598.50 $508.73 w/sphenoidotomy Nasal/sinus endoscopy, surgical; 31287-50 $897.75 $763.09 w/sphenoidotomy bilateral Stereotactic computer-assisted procedure; 61782 $460.25 $391.22 cranial, extradural Laryngoscopy, direct, operative, w/ biopsy; w/ 31536 $553.25 $470.27 operating microscope or telescope Palatopharyngoplasty, eg, 42145 $1,850.50 $1,572.93 uvulopalatopharyngoplasty Parathyroidectomy 60500 $2,547.50 $2,165.38 Thyroid Lobectomy, unilateral 60220 $1,862.50 $1,583.13 Thyroidectomy, total or complete 60240 $2,416.50 $2,054.03 Thyroidectomy, total for malignancy; with 60252 $3,473.00 $2,952.05 limited neck dissection Tympanoplasty 69631 $2,373.00 $2,017.05 Tympanomastoidectomy 69641 $2,778.25 $2,361.52 PE Tubes (Tympanostomy), general anesthesia 69436-SG $1810.20 $1,538.67 - Unilateral PE Tubes (Tympanostomy), general anesthesia 69436-50- $2,715.30 $2,308.00 - bilateral SG Tonsillectomy, primary or secondary; younger 42825-SG $5123.25 $4,354.76 than age 12 Tonsillectomy, primary or secondary; age 12 42826-SG $2,406.00 $2,045.10 or over Adenoidectomy, primary, younger than age 12 42830-SG $3,668.75 $3,118.44 Tonsillectomy and adenoidectomy; younger 42820-SG $5,123.25 $4,354.76 than age 12 Septoplasty 30520-SG $2,406.00 $2,045.20 Submucous resection inferior turbinate 30140-SG $2,406.00 $2,045.10 Submucous resection inferior turbinate 30140-50- $3,609.00 $3,067.65 bilateral SG Fracture nasal inferior turbinate(s), therapeutic 30930-SG $2,406.00 $2,045.10 Fracture nasal inferior turbinate(s), therapeutic 30930-50- $3,609.00 $3,067.65 bilateral SG Nasal/sinus endoscopy, surgical w/maxillary 31256-SG $2,822.50 $2,399.13 antrostomy Nasal/Sinus endoscopy, surgical w/maxillary 31256-50- $4,233.75 $3,598.69 antrostomy bilateral SG Nasal/sinus endoscopy, surgical; 31255-SG $4,323.50 $3,674.98 w/ethmoidectomy, total Nasal/sinus endoscopy, surgical; 31255-50- $6,485.25 $5,512.46 w/ethmoidectomy, total bilateral SG Nasal/sinus endoscopy, surgical; w/frontal 31276-SG $4,323.50 $3,674.98 sinus exploration Nasal/sinus endoscopy, surgical; w/frontal 31276-50- $6,485.25 $5,512.46 sinus exploration bilateral SG Nasal/sinus endoscopy, surgical; 31287-SG $4,323.50 $3,674.98 w/sphenoidotomy Nasal/sinus endoscopy, surgical; 31287-50- $6,485.25 $5,512.46 w/sphenoidotomy bilateral SG Stereotactic computer-assisted procedure; 61782-SG $109.25 $92.86 cranial, extradural Laryngoscopy, direct, operative, w/ biopsy; w/ 31536-SG $2,822.50 $2,399.13 operating microscope or telescope Palatopharyngoplasty, eg, 42145-SG $5,123.25 $4,354.76 uvulopalatopharyngoplasty Parathyroidectomy 60500-SG $5,123.25 $4,354.76 Tympanoplasty 69631-SG $5,123.25 $4,354.76 Tympanomastoidectomy 69641-SG $5,123.25 $4,354.76 PE Tubes (Tympanostomy), general anesthesia $474.00 - $402.90 - 00126 - unilateral or bilateral (30 - 45 min) $553.00 $470.05 Tonsillectomy, primary or secondary; younger $655.70 - $557.35 - 00170 than age 12 (50 - 60 min) $711.00 $604.35 Tonsillectomy, primary or secondary; age 12 $608.30 - $517.06 - 00170 or over (40 - 55 min) $687.30 $584.21 Adenoidectomy, primary, younger than age 12 $553.00 - $470.05 - 00170 (30 - 40 min) $608.30 $517.06 Tonsillectomy and adenoidectomy; younger $553.00 - $470.05 - 00170 than age 12 (30 - 45 min) $632.00 $537.20 *** Note: Range for 2-6 Procedures 60-200 $711.00 - $604.35 - 00160 minutes $1,501.00 $1,275.85 Septoplasty 00160 *** *** Submucous resection inferior turbinate 00160 *** *** Submucous resection inferior turbinate 00160 *** *** bilateral Fracture nasal inferior turbinate(s), therapeutic 00160 *** *** Fracture nasal inferior turbinate(s), therapeutic 00160 *** *** bilateral Nasal/sinus endoscopy, surgical w/maxillary 00160 *** *** antrostomy Nasal/Sinus endoscopy, surgical w/maxillary 00160 *** *** antrostomy bilateral Nasal/sinus endoscopy, surgical; 00160 *** *** w/ethmoidectomy, total Nasal/sinus endoscopy, surgical; 00160 *** *** w/ethmoidectomy, total bilateral Nasal/sinus endoscopy, surgical; w/frontal 00160 *** *** sinus exploration Nasal/sinus endoscopy, surgical; w/frontal 00160 *** *** sinus exploration bilateral Nasal/sinus endoscopy, surgical; 00160 *** *** w/sphenoidotomy Nasal/sinus endoscopy, surgical; 00160 *** *** w/sphenoidotomy bilateral Stereotactic computer-assisted procedure; 00160 *** *** cranial, extradural Laryngoscopy, direct, operative, w/biopsy; $632.00 - $537.20 - w/operating microscope or telescope (30 - 50 00320 $734.70 $624.50 min) Palatopharyngoplasty, eg, $869.00 - $738.65 - 00160 uvulopalatopharyngoplasty (90 - 120 min) $1,027.00 $872.95 $892.70 - $758.80 - Parathyroidectomy (80 - 90 min) 00320 $948.00 $805.80 $948.00 - $805.80 - Tympanoplasty (100 - 120 min) 00120 $1,027.00 $872.95 $1,343.00 - $1,141.55 - Tympanomastoidectomy (180 - 220 min) 00120 $1,548.40 $1,316.14

• A typical Adult Hearing Test includes 92557 and 92567. It may also include 92504. • A typical Pediatric Hearing Test includes 92582 and 92567. It may also include 92579.

*Indicates that injectable or infusion drug 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.