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 Blue Cross Blue Shield 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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573 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · case rate · outpatient | 4 | $2,193 | $1,413 – $3,179 |
| 2 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · bothfrom % of charges | 3 | $4,180 | $1,320 – $8,798 |
| 3 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · inpatientfrom % of charges | 3 | $4,093 | $1,320 – $8,543 |
| 4 | ALBANY MEDICAL CENTER HOSPITAL Albany, NY facility · percent of total billed charges · outpatientfrom % of charges | 3 | $4,080 | $1,320 – $8,500 |
| 5 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $125.22 | $125.22 – $125.22 |
| 6 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 5 | $146.22 | $13.17 – $551.35 |
| 7 | Adventhealth Port Charlotte Port Charlotte, FL fee schedule · outpatient | 1 | $133.85 | $133.85 – $133.85 |
| 8 | Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient | 1 | $123.09 | $123.09 – $123.09 |
| 9 | Alomere Health Alexandria, MN facility · fee schedule · outpatient | 2 | $0.01 | $0.01 – $0.01 |
| 10 | Alton Memorial Hospital Alton, IL other · both | 1 | $133.36 | $133.36 – $133.36 |
| 11 | Alton Memorial Hospital Alton, IL percent of total billed charges · bothfrom % of charges | 5 | $0.01 | $0.01 – $0.01 |
| 12 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 2 | $0.01 | $0.01 – $0.01 |
| 13 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 2 | $0.01 | $0.01 – $0.01 |
| 14 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 4 | $28.95 | $0.29 – $198.44 |
| 15 | Ascension Providence Waco, TX fee schedule · outpatient | 1 | $10.61 | $10.61 – $10.61 |
| 16 | Ascension Seton Austin, TX fee schedule · outpatient | 4 | $10.09 | $9.38 – $11.36 |
| 17 | Athens Hospital, LLC Athens, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $422.53 | $96.71 – $866.76 |
| 18 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL fee schedule · both | 1 | $134.50 | $134.50 – $134.50 |
| 19 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL percent of total billed charges · bothfrom % of charges | 6 | $13,687 | $1,166 – $43,710 |
| 20 | BELTON REGIONAL MEDICAL CENTER Kansas City, MO percent of total billed charges · outpatientfrom % of charges | 8 | $86.25 | $24.08 – $187.00 |
| 21 | BETHESDA HOSPITAL BOYNTON BEACH, FL fee schedule · both | 1 | $129.95 | $129.95 – $129.95 |
| 22 | BETHESDA HOSPITAL BOYNTON BEACH, FL percent of total billed charges · bothfrom % of charges | 7 | $19,382 | $4,582 – $45,868 |
| 23 | BOCA RATON REGIONAL HOSPITAL Delray Beach, FL case rate · both | 4 | $461.76 | $233.00 – $653.00 |
| 24 | BOCA RATON REGIONAL HOSPITAL Delray Beach, FL fee schedule · both | 1 | $127.62 | $127.62 – $127.62 |
| 25 | BSA Hospital Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 2 | $1,777 | $1,777 – $1,777 |
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