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 Medicare 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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54 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 1 | $5,467 | $5,467 – $5,467 |
| 2 | BAPTIST HOSPITAL OF MIAMI PLANTATION, FL fee schedule · both | 2 | $152.70 | $129.95 – $175.44 |
| 3 | BETHESDA HOSPITAL BOYNTON BEACH, FL fee schedule · both | 2 | $152.70 | $129.95 – $175.44 |
| 4 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 5 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 6 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 7 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $124.60 | $124.60 – $124.60 |
| 8 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $124.60 | $124.60 – $124.60 |
| 9 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $124.60 | $124.60 – $124.60 |
| 10 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT 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 Durango, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 13 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 14 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 15 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 2 | $124.60 | $124.60 – $124.60 |
| 16 | CATHOLIC HEALTH INITIATIVES COLORADO Fort Morgan, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 17 | COMMONSPIRIT KANSAS, INC. Dodge City, KS fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 18 | COMMONSPIRIT KANSAS, INC. Garden City, KS fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 19 | DOCTORS HOSPITAL CORAL GABLES, FL fee schedule · both | 2 | $152.70 | $129.95 – $175.44 |
| 20 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $155.34 | $155.34 – $155.34 |
| 21 | FISHERMENS HEALTH, INC MARATHON, FL percent of total billed charges · bothfrom % of charges | 2 | $7,033 | $1,415 – $19,123 |
| 22 | HOMESTEAD HOSPITAL Homestead, FL fee schedule · both | 2 | $152.70 | $129.95 – $175.44 |
| 23 | LONGMONT UNITED HOSPITAL Longmont, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 24 | Lakewood Medical Center Kansas City, MO facility · fee schedule · outpatient | 1 | $1,603 | $124.03 – $4,777 |
| 25 | MARINERS HOSPITAL TAVERNIER, FL percent of total billed charges · bothfrom % of charges | 2 | $7,033 | $1,415 – $19,123 |
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