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 Medica 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
102 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AHS Hillcrest Medical Center, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $9,458 | $3,359 – $20,036 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA percent of total billed charges · outpatientfrom % of charges | 1 | $279.54 | $263.85 – $295.23 |
| 3 | Alton Memorial Hospital Alton, IL other · both | 1 | $140.03 | $140.03 – $140.03 |
| 4 | Alton Memorial Hospital Alton, IL percent of total billed charges · bothfrom % of charges | 1 | $0.01 | $0.01 – $0.01 |
| 5 | Altru Hospital Grand Forks, ND facility · fee schedule · outpatient | 4 | $129.95 | $77.04 – $226.60 |
| 6 | Altru Hospital Devils Lake Devils Lake, ND facility · fee schedule · outpatient | 4 | $129.95 | $77.04 – $226.60 |
| 7 | Avera St. Luke's Aberdeen, SD percent of total billed charges · inpatientfrom % of charges | 2 | $8,869 | $2,822 – $21,646 |
| 8 | Avera St. Luke's Aberdeen, SD percent of total billed charges · outpatientfrom % of charges | 2 | $8,941 | $2,835 – $21,881 |
| 9 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL fee schedule · both | 1 | $139.05 | $139.05 – $139.05 |
| 10 | BETHESDA HOSPITAL BOYNTON BEACH, FL fee schedule · both | 1 | $129.95 | $129.95 – $129.95 |
| 11 | BSA Hospital Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $13,292 | $13,292 – $13,292 |
| 12 | Banner Wyoming Medical Center Casper, WY facility · percent of total billed charges · outpatientfrom % of charges | 1 | $268.97 | $100.71 – $437.22 |
| 13 | Barnes Jewish Hospital St. Louis, MO other · both | 1 | $130.88 | $130.88 – $130.88 |
| 14 | Barnes Jewish Hospital St. Louis, MO percent of total billed charges · bothfrom % of charges | 1 | $220.44 | $0.01 – $438.14 |
| 15 | Brookings Health System Brookings, SD fee schedule · outpatient | 1 | $2,993 | $1,467 – $5,063 |
| 16 | Brookings Health System Brookings, SD percent of total billed charges · outpatientfrom % of charges | 1 | $1,791 | $576.53 – $3,706 |
| 17 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $195.96 | $129.70 – $247.88 |
| 18 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $195.96 | $129.70 – $247.88 |
| 19 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $295.44 | $195.55 – $373.72 |
| 20 | Christian Hospital St. Louis, MO other · both | 1 | $130.88 | $130.88 – $130.88 |
| 21 | Christian Hospital St. Louis, MO percent of total billed charges · bothfrom % of charges | 1 | $226.54 | $0.01 – $438.14 |
| 22 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $214.04 | $141.67 – $270.76 |
| 23 | Curators of the University of Missouri Jefferson City, MO facility · percent of total billed charges · inpatientfrom % of charges | 1 | $193.83 | $63.00 – $285.25 |
| 24 | Curators of the University of Missouri Jefferson City, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $189.95 | $61.74 – $279.55 |
| 25 | DOCTORS HOSPITAL CORAL GABLES, FL fee schedule · both | 1 | $139.05 | $139.05 – $139.05 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e