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 Caresource 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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103 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $254.28 | $254.28 – $254.28 |
| 2 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $179.43 | $121.20 – $237.65 |
| 3 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 1 | $189.50 | $189.50 – $189.50 |
| 4 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $4,785 | $3,375 – $6,195 |
| 5 | Clinton Memorial Hospital Wilmington, OH fee schedule · outpatient | 1 | $156.45 | $156.45 – $156.45 |
| 6 | Dayton Osteopathic Hospital Dayton, OH fee schedule · outpatient | 1 | $189.50 | $189.50 – $189.50 |
| 7 | Deaconess Hospital, Inc Newburgh, IN facility · case rate · outpatient | 1 | $48.68 | $48.68 – $48.68 |
| 8 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $247.77 | $151.29 – $346.74 |
| 9 | Floyd Healthcare Management Inc Rome, GA percent of total billed charges · outpatientfrom % of charges | 1 | $347.56 | $9.90 – $699.87 |
| 10 | Fort Hamilton Hospital Hamilton, OH fee schedule · outpatient | 1 | $190.68 | $190.68 – $190.68 |
| 11 | Greene Memorial Hospital Inc Xenia, OH fee schedule · outpatient | 1 | $188.49 | $188.49 – $188.49 |
| 12 | Greenfield Area Medical Center Greenfield, OH facility · case rate · outpatient | 1 | $254.28 | $254.28 – $254.28 |
| 13 | Indiana University Health Arnett Inc. Lafayette, IN fee schedule · outpatient | 3 | $99.77 | $50.55 – $198.22 |
| 14 | Indiana University Health Ball Memorial Hospital Inc. Muncie, IN fee schedule · outpatient | 3 | $99.87 | $50.55 – $198.52 |
| 15 | Indiana University Health Bedford Inc. Bedford, IN fee schedule · outpatient | 2 | $50.55 | $50.55 – $50.55 |
| 16 | Indiana University Health Bloomington Inc. Bloomington, IN fee schedule · outpatient | 3 | $99.77 | $50.55 – $198.22 |
| 17 | Indiana University Health Frankfort Inc. Frankfort, IN fee schedule · outpatient | 2 | $50.55 | $50.55 – $50.55 |
| 18 | Indiana University Health Inc. Martinsville, IN fee schedule · outpatient | 3 | $99.77 | $50.55 – $198.22 |
| 19 | Indiana University Health Jay Inc. Portland, IN fee schedule · outpatient | 2 | $50.55 | $50.55 – $50.55 |
| 20 | Indiana University Health North Hospital Inc. Carmel, IN fee schedule · outpatient | 3 | $99.77 | $50.55 – $198.22 |
| 21 | Indiana University Health Paoli Inc. Paoli, IN fee schedule · outpatient | 2 | $50.55 | $50.55 – $50.55 |
| 22 | Indiana University Health Tipton Hospital Inc. Tipton, IN fee schedule · outpatient | 2 | $50.55 | $50.55 – $50.55 |
| 23 | Indiana University Health West Hospital Inc. Avon, IN fee schedule · outpatient | 3 | $99.77 | $50.55 – $198.22 |
| 24 | Indiana University Health White Memorial Hospital Inc. Monticello, IN fee schedule · outpatient | 2 | $50.55 | $50.55 – $50.55 |
| 25 | Kettering Medical Center Troy, OH fee schedule · outpatient | 1 | $188.49 | $188.49 – $188.49 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e