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 Regence 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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57 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | ALBANY GENERAL HOSPITAL Albany, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $1,685 | $90.94 – $14,988 |
| 2 | Clallam County Public Hospital District 2 DBA Olympic Medical Center Port Angeles, WA fee schedule · outpatient | 1 | $155.95 | $155.95 – $155.95 |
| 3 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $202.29 | $123.52 – $283.09 |
| 4 | GOOD SAMARITAN HOSPITAL CORVALLIS Corvallis, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $1,685 | $90.94 – $14,988 |
| 5 | GRITMAN MEDICAL CENTER INC Moscow, ID professional · fee schedule · outpatient | 1 | $123.88 | $123.88 – $123.88 |
| 6 | Good Samaritan Hospital Puyallup, WA fee schedule · outpatient | 1 | $146.60 | $146.60 – $146.60 |
| 7 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $287.14 | $188.58 – $367.07 |
| 8 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763.00 | $763.00 – $763.00 |
| 9 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $222.63 | $138.10 – $305.89 |
| 10 | IHC Health Services Inc., DBA Intermountain Health Bear River Valley Hospital Tremonton, UT facility · fee schedule · outpatient | 1 | $133.56 | $133.56 – $133.56 |
| 11 | IHC Health Services Inc., DBA Intermountain Health Intermountain Medical Center Murray, UT facility · fee schedule · outpatient | 1 | $126.00 | $126.00 – $126.00 |
| 12 | IHC Health Services Inc., DBA Intermountain Health Layton Hospital Layton, UT facility · case rate · outpatient | 1 | $132.23 | $132.23 – $132.23 |
| 13 | IHC Health Services Inc., DBA Intermountain Health Orem Community Hospital Orem, UT facility · fee schedule · outpatient | 1 | $131.04 | $131.04 – $131.04 |
| 14 | IHC Health Services Inc., DBA Intermountain Health Park City Hospital Park City, UT facility · fee schedule · outpatient | 1 | $133.56 | $133.56 – $133.56 |
| 15 | IHC Health Services Inc., DBA Intermountain Health Riverton Hospital Riverton, UT facility · fee schedule · outpatient | 1 | $126.76 | $126.76 – $126.76 |
| 16 | IHC Health Services Inc., DBA Intermountain Health St George Regional Hospital St. George, UT facility · fee schedule · outpatient | 1 | $133.56 | $133.56 – $133.56 |
| 17 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $193.95 | $118.42 – $271.42 |
| 18 | MID-VALLEY HEALTHCARE INC Lebanon, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $1,799 | $97.08 – $16,000 |
| 19 | MID-VALLEY HEALTHCARE INC Lebanon, OR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $638.33 | $34.45 – $5,678 |
| 20 | Mary Bridge Children's Hospital Tacoma, WA fee schedule · outpatient | 1 | $146.60 | $146.60 – $146.60 |
| 21 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $533.36 | $325.66 – $746.41 |
| 22 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $141.91 | $86.65 – $198.60 |
| 23 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $248.65 | $151.82 – $347.97 |
| 24 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $153.20 | $100.22 – $196.89 |
| 25 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $140.20 | $85.61 – $196.21 |
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