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 Amerihealth Caritas 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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41 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 | 1 | $287.30 | $8.18 – $578.51 |
| 3 | Atrium Health Hospitals Inc Lincolnton, NC percent of total billed charges · outpatientfrom % of charges | 1 | $229.67 | $6.54 – $462.48 |
| 4 | Atrium Health Hospitals Inc Wadesboro, NC percent of total billed charges · outpatientfrom % of charges | 1 | $304.60 | $8.68 – $613.36 |
| 5 | CATHOLIC MEDICAL CENTER MANCHESTER, NH percent of total billed charges · outpatientfrom % of charges | 1 | $164.85 | $164.85 – $164.85 |
| 6 | Caldwell Memorial Hospital Lenoir, NC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $72.18 | $25.21 – $140.51 |
| 7 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $444.08 | $12.65 – $894.21 |
| 8 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $444.08 | $12.65 – $894.21 |
| 9 | Carolinas Medical Center Davidson, NC percent of total billed charges · outpatientfrom % of charges | 1 | $444.08 | $12.65 – $894.21 |
| 10 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $444.08 | $12.65 – $894.21 |
| 11 | CentraState Medical Center Freehold Township, NJ other · outpatient | 1 | $2,144 | $2,144 – $2,144 |
| 12 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 1 | $2,144 | $2,144 – $2,144 |
| 13 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 1 | $2,144 | $2,144 – $2,144 |
| 14 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $276.30 | $181.46 – $353.21 |
| 15 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $214.23 | $132.89 – $294.34 |
| 16 | MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges | 1 | $4,305 | $1,050 – $6,853 |
| 17 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $5,788 | $1,556 – $14,830 |
| 18 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $6,810 | $1,920 – $17,175 |
| 19 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $5,477 | $1,276 – $14,722 |
| 20 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 1 | $6,094 | $1,364 – $16,602 |
| 21 | MedStar Southern Hospital Center Clinton, MD percent of total billed charges · outpatientfrom % of charges | 1 | $8,749 | $1,794 – $24,476 |
| 22 | MedStar St. Mary's Hospital Leonardtown, MD percent of total billed charges · outpatientfrom % of charges | 1 | $9,050 | $1,836 – $25,470 |
| 23 | MedStar Union Memorial Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $4,332 | $1,193 – $11,043 |
| 24 | Morristown Medical Center Morristown, NJ other · outpatient | 1 | $2,144 | $2,144 – $2,144 |
| 25 | Newton Medical Center Newton, NJ other · outpatient | 1 | $2,144 | $2,144 – $2,144 |
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