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 Magellan 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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42 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Atrium Health Hospitals Inc Kings Mountain, NC percent of total billed charges · outpatientfrom % of charges | 1 | $1,222 | $34.80 – $2,460 |
| 2 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $1,222 | $34.80 – $2,460 |
| 3 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $1,222 | $34.80 – $2,460 |
| 4 | Carolinas Medical Center Davidson, NC percent of total billed charges · outpatientfrom % of charges | 1 | $1,222 | $34.80 – $2,460 |
| 5 | Carolinas Medical Center Charlotte, NC percent of total billed charges · outpatientfrom % of charges | 1 | $1,222 | $34.80 – $2,460 |
| 6 | Chapman Global Medical Center Orange, CA facility · percent of total billed charges · inpatientfrom % of charges | 2 | $4,968 | $2,038 – $7,033 |
| 7 | Chapman Global Medical Center Orange, CA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $4,968 | $2,038 – $7,033 |
| 8 | MEDICAL CITY MCKINNEY MCKINNEY, TX percent of total billed charges · outpatientfrom % of charges | 2 | $723.60 | $723.60 – $723.60 |
| 9 | MedStar Franklin Square Medical Center Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $5,788 | $1,556 – $14,830 |
| 10 | MedStar Good Samaritan Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $6,810 | $1,920 – $17,175 |
| 11 | MedStar Harbor Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $5,477 | $1,276 – $14,722 |
| 12 | MedStar Montgomery Medical Center Olney, MD percent of total billed charges · outpatientfrom % of charges | 1 | $6,094 | $1,364 – $16,602 |
| 13 | MedStar Southern Hospital Center Clinton, MD percent of total billed charges · outpatientfrom % of charges | 1 | $8,749 | $1,794 – $24,476 |
| 14 | MedStar St. Mary's Hospital Leonardtown, MD percent of total billed charges · outpatientfrom % of charges | 1 | $9,050 | $1,836 – $25,470 |
| 15 | MedStar Union Memorial Hospital Baltimore, MD percent of total billed charges · outpatientfrom % of charges | 1 | $4,332 | $1,193 – $11,043 |
| 16 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $533.36 | $325.66 – $746.41 |
| 17 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $316.79 | $207.24 – $407.13 |
| 18 | Morristown Medical Center Morristown, NJ other · outpatient | 1 | $2,122 | $2,122 – $2,122 |
| 19 | Northwest Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $137.20 | $137.20 – $137.20 |
| 20 | Northwest Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121.89 | $121.89 – $121.89 |
| 21 | Northwest Sahurita Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121.89 | $121.89 – $121.89 |
| 22 | Northwest Sahurita Hospital LLC Sahuarita, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $121.89 | $121.89 – $121.89 |
| 23 | Orange County Global Medical Center Santa Ana, CA facility · percent of total billed charges · inpatientfrom % of charges | 2 | $4,968 | $2,038 – $7,033 |
| 24 | Orange County Global Medical Center Santa Ana, CA facility · percent of total billed charges · outpatientfrom % of charges | 2 | $4,968 | $2,038 – $7,033 |
| 25 | Oro Valley Hospital LLC Tucson, AZ facility · fee schedule · outpatient | 1 | $137.20 | $137.20 – $137.20 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e