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 Medicaid 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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17 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Brookings Health System Brookings, SD fee schedule · outpatient | 1 | $2,993 | $1,467 – $5,063 |
| 2 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $127.14 | $127.14 – $127.14 |
| 3 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $5,450 | $1,516 – $15,179 |
| 4 | Chapman Global Medical Center Orange, CA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1,656 | $679.20 – $2,344 |
| 5 | Chilton Medical Center Pompton Plains, NJ percent of total billed charges · bothfrom % of charges | 1 | $812.16 | $812.16 – $812.16 |
| 6 | MELROSEWAKEFIELD HEALTHCARE Medford, MA percent of total billed charges · bothfrom % of charges | 1 | $12,300 | $3,000 – $19,580 |
| 7 | Mercy Hospital Jefferson Imperial, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $154.47 | $26.70 – $506.25 |
| 8 | Morristown Medical Center Morristown, NJ percent of total billed charges · bothfrom % of charges | 1 | $925.13 | $925.13 – $925.13 |
| 9 | Northwest Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $116.09 | $116.09 – $116.09 |
| 10 | Ohio State University Hospitals Columbus, OH fee schedule · outpatient | 1 | $1.00 | $1.00 – $1.00 |
| 11 | Oro Valley Hospital LLC Tucson, AZ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $116.09 | $116.09 – $116.09 |
| 12 | Overlook Medical Center Summit, NJ percent of total billed charges · bothfrom % of charges | 1 | $984.15 | $381.92 – $1,273 |
| 13 | Piney Woods Healthcare System LP Lufkin, TX facility · fee schedule · outpatient | 1 | $79.08 | $79.08 – $79.08 |
| 14 | Saint Alphonsus Medical Center - Baker City Baker City, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $132.65 | $87.80 – $167.79 |
| 15 | Saint Alphonsus Medical Center - Ontario Ontario, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $90.44 | $59.86 – $114.41 |
| 16 | Southeast Hospital dba Mercy Hospital Southeast Girardeau, MO facility · percent of total billed charges · outpatientfrom % of charges | 1 | $37.80 | $37.80 – $37.80 |
| 17 | Tufts Medical Center BOSTON, MA percent of total billed charges · bothfrom % of charges | 1 | $12,300 | $3,000 – $19,580 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e