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 Anthem 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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244 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · fee schedule · outpatient | 3 | $254.34 | $117.73 – $348.80 |
| 2 | Aspirus Divine Savior Hospital Portage, WI fee schedule · outpatient | 2 | $514.94 | $123.29 – $906.58 |
| 3 | Aspirus Rhinelander Hospital Rhinelander, WI fee schedule · outpatient | 2 | $514.94 | $123.29 – $906.58 |
| 4 | Aspirus St. Luke’s Hospital Duluth, MN fee schedule · outpatient | 2 | $193.26 | $128.84 – $257.68 |
| 5 | Aspirus Stevens Point Hospital Stevens Point, WI fee schedule · outpatient | 2 | $514.94 | $123.29 – $906.58 |
| 6 | Aspirus Wausau Hospital Wausau, WI fee schedule · outpatient | 2 | $517.25 | $123.85 – $910.64 |
| 7 | Aspirus Wisconsin Rapids Hospital Wisconsin Rapids, WI fee schedule · outpatient | 2 | $514.94 | $123.29 – $906.58 |
| 8 | Atrium Medical Center Middletown, OH fee schedule · outpatient | 3 | $272.97 | $171.50 – $376.52 |
| 9 | Blue Hill Memorial Hospital Hill, ME professional · fee schedule · outpatient | 2 | $38.49 | $38.49 – $38.49 |
| 10 | Boulder Community Health Lafayette, CO facility · case rate · outpatient | 1 | $132.73 | $132.73 – $132.73 |
| 11 | Boulder Community Health Lafayette, CO facility · fee schedule · outpatient | 2 | $495.51 | $261.09 – $1,226 |
| 12 | Boulder Community Health Lafayette, CO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $11,438 | $5,042 – $19,743 |
| 13 | Boulder Community Health Lafayette, CO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $11,820 | $5,210 – $20,401 |
| 14 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 1 | $135.40 | $135.40 – $135.40 |
| 15 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 16 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO percent of total billed charges · inpatientfrom % of charges | 1 | $481.96 | $481.96 – $481.96 |
| 17 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO percent of total billed charges · outpatientfrom % of charges | 2 | $346.22 | $210.47 – $481.96 |
| 18 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 19 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 20 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO percent of total billed charges · inpatientfrom % of charges | 1 | $481.96 | $481.96 – $481.96 |
| 21 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO percent of total billed charges · outpatientfrom % of charges | 2 | $336.72 | $191.47 – $481.96 |
| 22 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 23 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 24 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 25 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO percent of total billed charges · inpatientfrom % of charges | 1 | $481.96 | $481.96 – $481.96 |
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