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 Devoted 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.
Filter by billing methodology
Filter by billing class
112 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Adventhealth Port Charlotte Port Charlotte, FL fee schedule · outpatient | 1 | $139.05 | $139.05 – $139.05 |
| 2 | Alton Memorial Hospital Alton, IL other · both | 1 | $140.03 | $140.03 – $140.03 |
| 3 | Barnes Jewish Hospital St. Louis, MO other · both | 1 | $130.88 | $130.88 – $130.88 |
| 4 | Boulder Community Health Lafayette, CO facility · case rate · outpatient | 1 | $136.71 | $136.71 – $136.71 |
| 5 | Boulder Community Health Lafayette, CO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $7,941 | $3,500 – $13,706 |
| 6 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 1 | $135.40 | $135.40 – $135.40 |
| 7 | Bryn Mawr Rehabilitation Hospital Malvern, PA facility · fee schedule · outpatient | 1 | $127.27 | $127.27 – $127.27 |
| 8 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 9 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 11 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 12 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 13 | CATHOLIC HEALTH INITIATIVES COLORADO Fort Morgan, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 14 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 2 | $126.97 | $126.97 – $126.97 |
| 15 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · fee schedule · outpatient | 1 | $117.73 | $117.73 – $117.73 |
| 16 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · fee schedule · outpatient | 1 | $117.73 | $117.73 – $117.73 |
| 17 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · fee schedule · outpatient | 1 | $117.73 | $117.73 – $117.73 |
| 18 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · fee schedule · outpatient | 1 | $117.73 | $117.73 – $117.73 |
| 19 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 2 | $126.97 | $126.97 – $126.97 |
| 20 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $121.37 | $121.37 – $121.37 |
| 21 | Christian Hospital St. Louis, MO other · both | 1 | $130.88 | $130.88 – $130.88 |
| 22 | Cleveland Clinic Weston Hospital Nonprofit Corporation Weston, FL facility · fee schedule · outpatient | 2 | $142.95 | $142.95 – $142.95 |
| 23 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $121.37 | $121.37 – $121.37 |
| 24 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 2 | $115.74 | $115.74 – $115.74 |
| 25 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 2 | $118.56 | $118.56 – $118.56 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e