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
MATRIX 12.5X10CM 125SQ CM RESTRATA SOFT NONFRIABLE ABSORBABLE WOUND STERILE LATEX FREE WHITE
The hospitals that file a Ambetter rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.
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187 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Alleghany County Memorial Hospital, Inc Sparta, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $692.27 | $19.72 – $1,394 |
| 2 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 2 | $694.72 | $18.53 – $1,488 |
| 3 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · inpatientfrom % of charges | 2 | $719.76 | $19.43 – $1,525 |
| 4 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 2 | $711.72 | $18.97 – $1,525 |
| 5 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · inpatientfrom % of charges | 2 | $703.98 | $18.53 – $1,525 |
| 6 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 2 | $690.14 | $17.74 – $1,525 |
| 7 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $7,769 | $3,802 – $11,252 |
| 8 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $7,769 | $3,802 – $11,252 |
| 9 | Baxter County Regional Hospital, Inc. Home, AR facility · fee schedule · outpatient | 1 | $169.06 | $169.06 – $169.06 |
| 10 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · inpatientfrom % of charges | 2 | $7,769 | $3,802 – $11,252 |
| 11 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $7,769 | $3,802 – $11,252 |
| 12 | Betsy Johnson Hospital Dunn, NC facility · other · outpatient | 1 | $189.78 | $189.78 – $189.78 |
| 13 | Brunswick Community Hospital, LLC Bolivia, NC fee schedule · outpatient | 1 | $300.33 | $300.33 – $300.33 |
| 14 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $223.70 | $223.70 – $223.70 |
| 15 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 2 | $665.30 | $16.85 – $1,488 |
| 16 | Carolinas Medical Center Charlotte, NC percent of total billed charges · inpatientfrom % of charges | 2 | $913.29 | $24.66 – $1,935 |
| 17 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 2 | $887.84 | $23.21 – $1,935 |
| 18 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 2 | $665.30 | $16.85 – $1,488 |
| 19 | CentraState Medical Center Freehold Township, NJ other · outpatient | 1 | $2,122 | $2,122 – $2,122 |
| 20 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $263.37 | $174.32 – $333.15 |
| 21 | Central Georgia Rehabilitation LLC Macon, GA percent of total billed charges · inpatientfrom % of charges | 1 | $1,038 | $29.58 – $2,091 |
| 22 | Central Georgia Rehabilitation LLC Macon, GA percent of total billed charges · outpatientfrom % of charges | 1 | $610.83 | $17.40 – $1,230 |
| 23 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 1 | $2,122 | $2,122 – $2,122 |
| 24 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $223.70 | $223.70 – $223.70 |
| 25 | Cumberland County Hospital System Inc Fayetteville, NC facility · other · outpatient | 1 | $253.04 | $253.04 – $253.04 |
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