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 Optum 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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77 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Betsy Johnson Hospital Dunn, NC facility · other · outpatient | 1 | $126.52 | $126.52 – $126.52 |
| 2 | Bexar County Hospital District San Antonio, TX percent of total billed charges · outpatientfrom % of charges | 1 | $12,855 | $205.00 – $61,188 |
| 3 | CATHOLIC HEALTH INIATIVES COLORADO Westminster, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO Pueblo, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 5 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 6 | CATHOLIC HEALTH INITIATIVES COLORADO Frisco, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 7 | CATHOLIC HEALTH INITIATIVES COLORADO Durango, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 8 | CATHOLIC HEALTH INITIATIVES COLORADO Lakewood, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 9 | CATHOLIC HEALTH INITIATIVES COLORADO Colorado Springs, CO fee schedule · outpatient | 1 | $124.60 | $124.60 – $124.60 |
| 10 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · outpatient | 1 | $120.92 | $120.92 – $120.92 |
| 11 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · outpatient | 1 | $120.92 | $120.92 – $120.92 |
| 12 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $120.92 | $120.92 – $120.92 |
| 13 | Cocke County HMA, LLC Newport, TN facility · per diem · outpatient | 1 | $120.92 | $120.92 – $120.92 |
| 14 | Cumberland County Hospital System Inc Fayetteville, NC facility · other · outpatient | 1 | $126.52 | $126.52 – $126.52 |
| 15 | FORT LOUDOUN MEDICAL CENTER Lenoir City, TN fee schedule · outpatient | 1 | $112.91 | $112.91 – $112.91 |
| 16 | FORT SANDERS REGIONAL MEDICAL CENTER Knoxville, TN fee schedule · both | 1 | $112.91 | $112.91 – $112.91 |
| 17 | Fairview Health Services Minneapolis, MN percent of total billed charges · outpatientfrom % of charges | 1 | $86.61 | $86.61 – $86.61 |
| 18 | Fisher-Titus Medical Center Norwalk, OH facility · fee schedule · outpatient | 1 | $85.97 | $85.97 – $85.97 |
| 19 | HMH HOSPITALS CORPORATION Hackensack, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $491.11 | $19.69 – $2,237 |
| 20 | Holy Name Teaneck, NJ facility · fee schedule · outpatient | 1 | $98.70 | $98.70 – $98.70 |
| 21 | Houston Methodist Baytown Hospital Baytown, TX fee schedule · outpatient | 1 | $243.77 | $243.77 – $243.77 |
| 22 | Houston Methodist Clear Lake Hospital Nassau Bay, TX fee schedule · outpatient | 1 | $243.77 | $243.77 – $243.77 |
| 23 | Houston Methodist Cypress Hospital Cypress, TX fee schedule · outpatient | 1 | $243.77 | $243.77 – $243.77 |
| 24 | Houston Methodist The Woodlands Hospital The Woodlands, TX fee schedule · outpatient | 1 | $243.77 | $243.77 – $243.77 |
| 25 | Jefferson County HMA LLC Jefferson City, TN facility · per diem · outpatient | 1 | $112.91 | $112.91 – $112.91 |
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