How Much Does Repair of S/n/ax/general/trk7.6-12.5cm Cost?
Also known as: Rpr s/n/ax/gen/trk7.6-12.5cm (CPT 12004)
Repair of S/n/ax/general/trk7.6-12.5cm (CPT 12004) costs $72 at Medicare rates. Hospital outpatient rate: $205.
Cost Comparison by Payer
How much Rpr s/n/ax/gen/trk7.6-12.5cm costs across different settings and payers
Procedures Commonly Done Together
These procedures are frequently performed alongside Rpr s/n/ax/gen/trk7.6-12.5cm
What Insurance Companies Actually Pay
Real negotiated rates from 15 hospitals across 6 states (from hospital price transparency filings)
| Insurance Company | Avg Rate | Range | Hospitals |
|---|---|---|---|
| Aetna | $1,854 | $178 - $4,833 | 9 |
| Cigna | $1,069 | $0 - $3,244 | 8 |
| United | $1,280 | $191 - $2,749 | 9 |
| Humana | $1,996 | $187 - $4,690 | 8 |
| KAISER FOUNDATION HEALTH PLAN, INC. | $415 | $240 - $752 | 5 |
| BCBS | $314 | $76 - $477 | 4 |
| BCBS-TX | $243 | $131 - $335 | 2 |
| Superior Health Plan | $889 | $299 - $948 | 3 |
| CHC | $630 | $136 - $934 | 2 |
| Multiplan | $548 | $321 - $962 | 5 |
| Anthem | $3,592 | $2,125 - $4,764 | 2 |
| UNITED | $192 | $73 - $424 | 2 |
How to Reduce Your Cost for Rpr s/n/ax/gen/trk7.6-12.5cm
Practical tips that can save you hundreds or thousands of dollars
- 1 Ask about cash-pay discounts
Many hospitals and clinics offer 20-40% discounts for self-pay patients. Always ask before scheduling.
- 2 Compare facility vs. office setting costs
For this procedure, the office rate ($162) differs from the facility rate ($72). Ask if it can be done in an office setting.
- 3 Shop around — costs vary significantly
Costs can vary 2-3x between providers in the same city. Get quotes from multiple facilities.
How is the Price Calculated?
Medicare calculates procedure payments using Relative Value Units (RVUs). Each procedure has three components multiplied by a conversion factor ($33.40 in 2026) and adjusted by geographic cost indices.
Payment = Total RVU (4.85) x CF ($33.40) = $162
Related Procedures
Similar procedures in the same category or body system
Frequently Asked Questions
How much does Rpr s/n/ax/gen/trk7.6-12.5cm cost?
The Medicare facility rate for Rpr s/n/ax/gen/trk7.6-12.5cm is $72. In a hospital outpatient setting, the rate is $205. Commercial insurance rates typically range from 150% to 250% of Medicare (varies by plan).
How much does Rpr s/n/ax/gen/trk7.6-12.5cm cost without insurance?
Without insurance, the cost of Rpr s/n/ax/gen/trk7.6-12.5cm can range from 150% of Medicare to 500% of Medicare depending on the facility. Many hospitals and clinics offer self-pay discounts of 20-40% off their chargemaster price. Always ask about cash pricing before your visit.
Does insurance cover Rpr s/n/ax/gen/trk7.6-12.5cm?
Most commercial health insurance plans and Medicare cover Rpr s/n/ax/gen/trk7.6-12.5cm when ordered by a physician for a medically necessary reason. Your out-of-pocket cost depends on your plan's deductible, copay/coinsurance structure, and whether you use an in-network provider. Check with your insurance company before scheduling to confirm coverage and get a cost estimate.
Why does the cost vary so much by location?
Medicare adjusts payments using Geographic Practice Cost Indices (GPCIs) that reflect local differences in physician work costs, practice expenses, and malpractice insurance. Manhattan, San Francisco, and other high-cost areas pay significantly more than rural regions. Commercial insurers follow similar geographic patterns.