Dermatology Provider Visit & Services Billing (CPT) The Everett Clinic Self- Prompt Pay Incentive Service Code** Pay Fee 15% Office Visit New Patient Level 3 - 99203 - 99204 $282.25 - $430.00 $239.92 - $365.50 Level 4 Office Visit Established Level 3 - 99213 - 99214 $195.75 - $282.75 $166.39 - $240.34 Level 4 Note: Complex visits may be billed at a higher level of service and cost. Procedures & Tests Billing (CPT) The Everett Clinic Self Prompt Pay Incentive Service Code Pay Fee 15% Patch Testing (66 Patches per 95044 $16.25 $13.82 treatment) Photo Therapy 96910 $385.50 $327.68 Photodynamic Therapy (PDT) 96567 $443.50 $376.98 Administration Supply - Levulan Kerasticks J7308 $815.75 $693.39 (1-2 Sticks per treatment) Removal of Skin Tags 11200 $242.00 $205.70 Wart or Lesion Removal 1 17000 $197.25 $167.67 (Premalignant) Wart or Lesion Removal 2-14 17003 $16.75 $14.24 (Premalignant) Wart of Lesion Removal up to 14 17110 $309.25 $262.87 (Benign) Wart of Lesion Removal 15+ 17004 $432.25 $367.42 (Premalignant or Benign) Injectables - Billed Per Unit Billing (CPT) The Everett Clinic Self Prompt Pay Service Code Pay Fee Incentive 15% **Injection Admin (Keloid Scar or 11900 $150.00 $127.50 Wart, up to 7) Triamcinolone Acetonide Injection J3301 $4.00 $3.40 Biopsy Billing (CPT) The Everett Clinic Self Prompt Pay Service Code Pay Fee Incentive 15% *Biopsy of Skin Lesion 11102 $276.50 $235.03 *Biopsy of Skin Lesion - Each added Lesion 11103 $146.50 $124.53 *Excision of Benign Lesion Trunk, Arms or 11400 $346.50 $294.53 Legs (Less than .6cm) *Excision of Benign Lesion Trunk, Arms or 11401 $419.50 $356.58 Legs (.6-10cm) *Excision of Benign Lesion Trunk, Arms or 11402 $464.75 $395.04 Legs (1.1-2.0cm) Pathology Billing (CPT) The Everett Clinic Self Pay Prompt Pay Incentive Service Code Fee 15% Pathology - 1 Charge Per Specimen 88305 $205.00 $174.25 *Indicates that one pathology charge will be billed per biopsy/excision. **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 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. .