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 Medical Mutual 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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70 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 1 | $118.83 | $118.83 – $118.83 |
| 2 | Bethesda Hospital Inc. Lebanon, OH facility · fee schedule · outpatient | 1 | $123.70 | $123.70 – $123.70 |
| 3 | Catholic Health Initiatives-Iowa Corp Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $104.61 | $69.24 – $132.33 |
| 4 | Catholic Health Initiatives-Iowa Corp West Des Moines, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $104.61 | $69.24 – $132.33 |
| 5 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $221.88 | $146.86 – $280.67 |
| 6 | Covenant Medical Center Inc Waterloo, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $269.21 | $178.19 – $340.55 |
| 7 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $258.29 | $157.71 – $361.47 |
| 8 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $123.53 | $74.41 – $157.67 |
| 9 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $83.77 | $50.46 – $106.92 |
| 10 | McCullough-Hyde Memorial Hospital, Inc. Oxford, OH facility · fee schedule · outpatient | 1 | $123.70 | $123.70 – $123.70 |
| 11 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $229.24 | $139.97 – $320.82 |
| 12 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $260.37 | $158.98 – $364.38 |
| 13 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $198.95 | $130.15 – $255.68 |
| 14 | Mercy Health Services-Iowa Corp. Mason City, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $158.27 | $104.76 – $200.21 |
| 15 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $277.05 | $183.38 – $350.46 |
| 16 | Mercy Medical Center - Dubuque Dubuque, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $251.73 | $166.62 – $318.43 |
| 17 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $249.32 | $165.02 – $315.38 |
| 18 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $320.74 | $195.84 – $448.87 |
| 19 | Mercy Medical Center - Newton Newton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $282.48 | $186.97 – $357.32 |
| 20 | Mercy Medical Center-Clinton Inc Clinton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $263.79 | $174.60 – $333.68 |
| 21 | Metrohealth System Parma, OH facility · fee schedule · outpatient | 2 | $242.23 | $64.09 – $468.21 |
| 22 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $157.58 | $96.22 – $220.53 |
| 23 | Mount Carmel East Reynoldsburg, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $295.19 | $180.24 – $413.10 |
| 24 | Mount Carmel Grove City Grove City, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $307.72 | $187.89 – $430.63 |
| 25 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $307.72 | $187.89 – $430.63 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e