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CPT 12004

Wound Repair - All Levels

Current code53 hospitals with prices

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 Washington hospitals publish for this code

Medicaid managed care: Rate for an Apple Health managed-care plan. Applies only to members of that plan.

HospitalMedicaid managed care rates (lowest – highest)Cash priceList price (before discounts)
BHC Fairfax HospitalKirkland—$110 – $183$110 – $183
Cascade Medical CenterLeavenworth$338 – $5644 plansDoctor’s fee: $269 – $404$486 – $540Doctor’s fee: $386$607 – $675Doctor’s fee: $483
Coulee Medical CenterGrand Coulee—$199$222
Deaconess Medical CenterSpokaneFile dated 2026-08-27—$321$802
EvergreenHealth Medical CenterKirkland—$992$1,240
EvergreenHealth MonroeMonroe$2191 plan$780$975
Harborview Medical CenterSeattleFile dated 2026-04-01—$1,387$1,981
Highline Medical CenterBurienFile dated 2026-02-28—$377$1,233
Island HospitalAnacortes$132 – $1433 plans$158 – $343$158 – $343
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01—$883$1,261
Legacy Salmon Creek Medical CenterVancouverFile dated 2026-04-01—$242$373
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27—$321$802
Olympic Medical CenterPort AngelesFile dated 2026-06-24$163 – $1795 plans$302$377
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01—$758$1,515
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01—$474$677
Providence Centralia HospitalCentraliaFile dated 2026-04-01—$578$1,111
Providence Holy Family HospitalSpokaneFile dated 2026-04-01—$509$727
Providence Mount Carmel HospitalColvilleFile dated 2026-04-01—$128 – $160$183 – $229
Providence Regional Medical Center EverettEverettFile dated 2026-04-01—$361$694
Providence St Joseph HospitalChewelahFile dated 2026-04-01—$160 – $167$229 – $238
Providence St Mary Medical CenterWalla WallaFile dated 2026-04-01—$236 – $585$337 – $835
Providence St Peter HospitalOlympiaFile dated 2026-04-01—$578$1,111
Seattle Children's HospitalSeattle$42.55 – $36613 plans$1,125$304 – $1,125
St Anthony HospitalGig HarborFile dated 2026-02-28—$375$1,233
St Clare HospitalLakewoodFile dated 2026-02-28—$356$1,233
St Elizabeth HospitalEnumclawFile dated 2026-02-28$345 – $4095 plans$436$1,233
St Francis Community HospitalFederal WayFile dated 2026-02-28—$387$1,233
St Joseph Medical CenterTacomaFile dated 2026-02-28—$409$1,233
St Michael Medical CenterSilverdaleFile dated 2026-02-28—$544$1,233
Swedish IssaquahIssaquahFile dated 2026-04-01—$608$1,266
Swedish Medical CenterSeattleFile dated 2026-04-01—$608$1,266
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01—$608$1,266
Three Rivers HospitalBrewsterDoctor’s fee: $413Doctor’s fee: $590Doctor’s fee: $590
Trios HealthKennewick——$51,434
University of Washington Medical CtrSeattleFile dated 2026-04-01—$956$1,365
Virginia Mason Medical CenterSeattle—$370$725
Yakima Valley MemorialYakimaFile dated 2026-08-27—$456$1,140

Lowest and highest amounts each hospital lists for this code during a hospital stay, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

Medicare (traditional) reference

Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.

Doctor's fee, Seattle (King County)
$186 in an office; $75.73 in a hospital or surgery center
Doctor's fee, rest of Washington
$165 in an office; $70.88 in a hospital or surgery center
Hospital outpatient payment (national)
$205 (APC 5051)