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 Molina 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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247 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | AMH Cath Labs LLC Arlington, TX case rate · outpatient | 1 | $131.48 | $131.48 – $131.48 |
| 2 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 1 | $32.23 | $14.22 – $64.22 |
| 3 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5,388 | $5,388 – $5,388 |
| 4 | Adena Fayette Medical Center Washington Court House, OH facility · case rate · outpatient | 1 | $260.64 | $260.64 – $260.64 |
| 5 | Adena Health System Chillicothe, OH facility · fee schedule · outpatient | 2 | $181.21 | $118.83 – $243.59 |
| 6 | Agnesian Healthcare Inc. Fond Du Lac, WI fee schedule · outpatient | 1 | $92.32 | $92.32 – $92.32 |
| 7 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 1 | $198.44 | $198.44 – $198.44 |
| 8 | Bartow Regional Medical Center Bartow, FL facility · case rate · outpatient | 1 | $335.36 | $335.36 – $335.36 |
| 9 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $4,374 | $2,141 – $6,335 |
| 10 | Bartow Regional Medical Center Bartow, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $2,995 | $684.36 – $6,650 |
| 11 | BayCare Alliant Hospital Dunedin, FL facility · case rate · outpatient | 1 | $335.36 | $335.36 – $335.36 |
| 12 | Baycare Hospital Wesley Chapel Chapel, FL facility · case rate · outpatient | 1 | $335.36 | $335.36 – $335.36 |
| 13 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · inpatientfrom % of charges | 1 | $4,374 | $2,141 – $6,335 |
| 14 | Baycare Hospital Wesley Chapel Chapel, FL facility · percent of total billed charges · outpatientfrom % of charges | 2 | $2,995 | $684.36 – $6,650 |
| 15 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $202.41 | $202.41 – $202.41 |
| 16 | Beavercreek Medical Center Springfield, OH fee schedule · outpatient | 2 | $191.67 | $128.75 – $254.58 |
| 17 | CATHOLIC HEALTH INITIATIVES COLORADO West Valley City, UT fee schedule · outpatient | 2 | $195.80 | $127.14 – $264.45 |
| 18 | CATHOLIC HEALTH INITIATIVES COLORADO West Jordan, UT fee schedule · outpatient | 2 | $195.80 | $127.14 – $264.45 |
| 19 | CATHOLIC HEALTH INITIATIVES COLORADO Lehi, UT fee schedule · outpatient | 2 | $195.80 | $127.14 – $264.45 |
| 20 | CATHOLIC HEALTH INITIATIVES COLORADO Layton, UT fee schedule · outpatient | 1 | $264.45 | $264.45 – $264.45 |
| 21 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $264.45 | $264.45 – $264.45 |
| 22 | Carle BroMenn Medical Center Normal, IL case rate · outpatient | 1 | $133.36 | $133.36 – $133.36 |
| 23 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $190.33 | $125.98 – $240.77 |
| 24 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $200.50 | $200.50 – $200.50 |
| 25 | Covenant Medical Center Inc Saginaw, MI facility · case rate · outpatient | 2 | $96.82 | $66.49 – $127.14 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e