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
HC RPR WD/SMP/SLP/N7.6-12.5
Hanover, PA
See all hospitals reporting CPT 12004 →Price type
UPMC Hanover’s median price of $630 is 120% above the median hospital's median price ($287), higher than 81% 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: 9 payers, 21 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 | Amerihealth Caritas community healthchoices (chc)/medicaid facility · fee schedule · outpatient | $62 | $62 | — | — | — | $62 – $62 |
| 2 | Highmark medicare facility · fee schedule · outpatient | $188 | $188 | — | — | — | $188 – $188 |
| 3 | Humana medicare facility · fee schedule · outpatient | $190 | $190 | — | — | — | $190 – $190 |
| 4 | Aetna medicare facility · fee schedule · outpatient | $198 | $198 | — | — | — | $198 – $198 |
| 5 | Cigna medicare facility · fee schedule · outpatient | $199 | $199 | — | — | — | $199 – $199 |
| 6 | UnitedHealthcare medicare facility · fee schedule · outpatient | $203 | $203 | — | — | — | $203 – $203 |
| 7 | Blue Cross Blue Shield medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $256 | $256 | — | — | — | $256 – $256 |
| 8 | Highmark medicaid facility · fee schedule · outpatient | $346 | $346 | $284 | 82% | — | $62 – $630 |
| 9 | Highmark commercial facility · fee schedule · outpatient | $675 | $675 | — | — | — | $675 – $675 |
| 10 | Aetna aco facility · percent of total billed charges · outpatientfrom % of charges | $765 | $765 | — | — | — | $765 – $765 |
| 11 | Blue Cross Blue Shield chip facility · percent of total billed charges · outpatientfrom % of charges | $915 | $915 | — | — | — | $915 – $915 |
| 12 | Blue Cross Blue Shield commercial facility · percent of total billed charges · outpatientfrom % of charges | $915 | $915 | — | — | — | $915 – $915 |
| 13 | UnitedHealthcare pa medicaid facility · fee schedule · outpatient | $967 | $967 | — | — | — | $967 – $967 |
| 14 | Aetna commercial facility · percent of total billed charges · outpatientfrom % of charges | $981 | $981 | — | — | — | $981 – $981 |
| 15 | UnitedHealthcare commercial facility · percent of total billed charges · outpatientfrom % of charges | $991 | $991 | — | — | — | $991 – $991 |
| 16 | Cigna commercial facility · percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 17 | Carefirst commercial facility · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 18 | Carefirst commercial facility · percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 19 | MultiPlan ppo (includes phcs and humana as payers) facility · percent of total billed charges · inpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 20 | MultiPlan ppo (includes phcs and humana as payers) facility · percent of total billed charges · outpatientfrom % of charges | $1.1k | $1.1k | — | — | — | $1.1k – $1.1k |
| 21 | Cigna commercial facility · case rate · outpatient | $9.5k | $9.5k | — | — | — | $9.5k – $9.5k |
Last updated: Mar 6, 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.