Cost Estimator
General Hospitals| Cash| S/N/T/G/E 7.6-12.5 cm
ESTIMATE FOR
S/N/T/G/E 7.6-12.5 cm
CPT: 12004 
at General Hospitals
using Cash - No Insurance
11/11/2026 10:40 PM
General Hospitals Estimate
Patient portion estimate
$528.00*
Facility fee
$528.00
3rd party fees
Billed separately
*You may receive bills from any 3rd party providers involved with this procedure.
Pay in Full
$475.20
10% OFF for 30 days
Pay in Full 15
$448.80
15% OFF for 5000 days
2 Month Plan
$264.00
Test 1 Month
$47.52
10% OFF for 20 days
3 Month Plan
$176.00
4 Month Plan
$132.00
5 month plan
$105.60
6 Month Plan
$88.00
12 Month Plan
$44.00
This estimate covers only the fees from General Hospitals and may not include any 3rd party fees you may incur.
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Call (555) 888-9999
Cost Detail
Total starting charges
$528.00
Cash Discount
$0.00
Total Estimated Patient Portion
$528.00

This price estimate, including payment options, is based on the selections you made and compared to what the expected charges will be for those services. Actual costs can change. Estimates with insurance factored in are based on your coverage at the time the estimate was given, which coverage may be different at the time of service. Please check with our Billing team prior to being seen for an updated estimate. See our full Terms of Use for details.

Cost data updated 11/7/2026 10:00 PM
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