Every billing code / CPT 12004 / Providence Holy Family Hospital
CPT 12004 at Providence Holy Family Hospital
Wound Repair - All Levels
Providence Holy Family Hospital, Spokane
This name is the CMS category the code belongs to (CMS's Restructured BETOS Classification System), shared with similar codes. The official CPT description belongs to the American Medical Association and isn't shown.
What Providence Holy Family Hospital publishes for this code: as an outpatient
Providence Holy Family Hospital’s prices for CPT 12004, as an outpatient| Who pays | Hospital’s fee (lowest – highest) | Doctor’s fee the hospital lists |
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| Commercial insuranceInsurer rates | $268 – $3,37913 plans | — |
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| Medicare AdvantageInsurer rates | $224 – $2465 plans | — |
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| Cash pricePaying yourself, without insurance | $509 | — |
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| List priceBefore any discount; few people pay it | $727 | — |
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Lowest and highest amounts Providence Holy Family Hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. Its price file is dated 2026-04-01. This is one line of a bill; most care brings several.
Bills to expect
The hospital’s fee is the price above. Doctors usually send their own bills. Their amounts here are what original Medicare allows in the rest of Washington for 2026, and a private-plan estimate of 118% to 179% of that (the range found across studies of what insurers pay doctors). Those are estimates, not quotes.
Bills to expect for CPT 12004 at Providence Holy Family Hospital| Bill | What it’s for | Original Medicare allows | Private plan estimate |
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| Hospital's feeThe hospital | The operating or procedure room, nursing, supplies and recovery | — | The price above |
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| Surgeon or doctor doing itThe doctor's practice | The procedure | $70.88 | $83.64 – $127 |
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| AnesthesiaAn anesthesia group (only sometimes) | Anesthesia or deep sedation, if you need itOnly if an anesthesia team is part of your care. Its amount depends on how long it takes. | — | — |
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Original Medicare amounts are only for people on original Medicare. Your share depends on your plan’s deductible, copay and coinsurance.
Compare CPT 12004 at every Washington hospital, with Medicare’s reference amounts.