Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
RPR S/N/AX/GEN/TRK7.6-12.5CM
Folsom, CA
See all hospitals reporting CPT 12004 →Price type
Dignity Health’s median price of $420 is 46% above the median hospital's median price ($287), higher than 68% of the 2,435 hospitals reporting CPT 12004. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 7 payers, 26 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare medicaid|< 21 fee schedule · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 2 | UnitedHealthcare medicaid|> 21 fee schedule · outpatient | $97 | $97 | — | — | — | $97 – $97 |
| 3 | Anthem medicaid|all plans fee schedule · outpatient | $229 | $229 | — | — | — | $229 – $229 |
| 4 | Anthem medicare|all other plans fee schedule · outpatient | $246 | $246 | — | — | — | $246 – $246 |
| 5 | Aetna medicare|all plans fee schedule · outpatient | $261 | $261 | — | — | — | $261 – $261 |
| 6 | Blue Cross Blue Shield medicare|hmo case rate · outpatient | $261 | $261 | — | — | — | $261 – $261 |
| 7 | Blue Cross Blue Shield medicare|ppo fee schedule · outpatient | $261 | $261 | — | — | — | $261 – $261 |
| 8 | Humana commercial|all plans fee schedule · outpatient | $261 | $261 | — | — | — | $261 – $261 |
| 9 | Kaiser medicare|all plans case rate · outpatient | $261 | $261 | — | — | — | $261 – $261 |
| 10 | UnitedHealthcare medicare|all plans case rate · outpatient | $261 | $261 | — | — | — | $261 – $261 |
| 11 | Anthem medicare|imperial fee schedule · outpatient | $269 | $269 | — | — | — | $269 – $269 |
| 12 | Molina medicaid|all plans fee schedule · outpatient | $286 | $286 | — | — | — | $286 – $286 |
| 13 | Kaiser medicaid|all plans percent of total billed charges · outpatientfrom % of charges | $480 | $480 | — | — | 1–10 | $480 – $480 |
| 14 | Blue Cross Blue Shield commercial|aco trio case rate · outpatient | $856 | $856 | — | — | — | $856 – $856 |
| 15 | Blue Cross Blue Shield commercial|exchange case rate · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 16 | Blue Cross Blue Shield commercial|aco trio calpers case rate · outpatient | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 17 | Blue Cross Blue Shield commercial|ppo tandem case rate · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 18 | Blue Cross Blue Shield commercial|hmo case rate · outpatient | $1.6k | $1.6k | — | — | — | $1.6k – $1.6k |
| 19 | Blue Cross Blue Shield commercial|calpers case rate · outpatient | $1.7k | $1.7k | — | — | — | $1.7k – $1.7k |
| 20 | Blue Cross Blue Shield commercial|all other plans case rate · outpatient | $1.9k | $1.9k | — | — | — | $1.9k – $1.9k |
| 21 | Anthem commercial|connection epo case rate · outpatient | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 22 | Aetna commercial|all other plans case rate · outpatient | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 23 | Aetna commercial|hmo case rate · outpatient | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 24 | Aetna commercial|ppo case rate · outpatient | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
| 25 | Anthem commercial|all other plans case rate · outpatient | $7.1k | $7.1k | — | — | — | $7.1k – $7.1k |
Last updated: Feb 28, 2026
See Repair of a superficial wound, 7.6 to 12.5 cm pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.