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 Superior Healthplan 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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24 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | HCA HOUSTON HEALTHCARE CLEAR LAKE WEBSTER, TX percent of total billed charges · outpatientfrom % of charges | 5 | $34.44 | $25.74 – $43.14 |
| 2 | HCA HOUSTON HEALTHCARE CONROE CONROE, TX percent of total billed charges · outpatientfrom % of charges | 5 | $47.33 | $23.28 – $93.48 |
| 3 | HCA HOUSTON HEALTHCARE KINGWOOD KINGWOOD, TX percent of total billed charges · outpatientfrom % of charges | 5 | $188.79 | $100.80 – $341.46 |
| 4 | HCA HOUSTON HEALTHCARE NORTHWEST HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 5 | $229.26 | $128.34 – $434.58 |
| 5 | HCA HOUSTON HEALTHCARE SOUTHEAST HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 5 | $124.27 | $71.46 – $213.17 |
| 6 | HCA HOUSTON HEALTHCARE TOMBALL Tomball, TX percent of total billed charges · outpatientfrom % of charges | 5 | $184.89 | $123.36 – $286.62 |
| 7 | HCA HOUSTON HEALTHCARE WEST STAFFORD, TX percent of total billed charges · outpatientfrom % of charges | 5 | $88.02 | $41.34 – $170.88 |
| 8 | HCA HOUSTON MAINLAND Texas City, TX percent of total billed charges · outpatientfrom % of charges | 5 | $34.44 | $25.74 – $43.14 |
| 9 | HCA Houston Healthcare North Cypress CYPRESS, TX percent of total billed charges · outpatientfrom % of charges | 5 | $179.14 | $96.24 – $264.18 |
| 10 | HCA Houston Rehabilitation Hospital Southeast Pasadena, TX percent of total billed charges · outpatientfrom % of charges | 5 | $124.27 | $71.46 – $213.17 |
| 11 | MEDICAL CITY ARLINGTON GRAND PRAIRIE, TX percent of total billed charges · outpatientfrom % of charges | 5 | $89.53 | $89.53 – $89.53 |
| 12 | MEDICAL CITY DALLAS GARLAND, TX percent of total billed charges · outpatientfrom % of charges | 5 | $63.18 | $45.50 – $83.09 |
| 13 | MEDICAL CITY DECATUR DECATUR, TX percent of total billed charges · outpatientfrom % of charges | 5 | $187.04 | $187.04 – $187.04 |
| 14 | MEDICAL CITY DENTON Denton, TX percent of total billed charges · outpatientfrom % of charges | 5 | $237.64 | $69.72 – $872.13 |
| 15 | MEDICAL CITY FORT WORTH FORT WORTH, TX percent of total billed charges · outpatientfrom % of charges | 5 | $163.26 | $107.03 – $203.91 |
| 16 | MEDICAL CITY LEWISVILLE Lewisville, TX percent of total billed charges · outpatientfrom % of charges | 5 | $180.53 | $180.53 – $180.53 |
| 17 | MEDICAL CITY MCKINNEY MCKINNEY, TX percent of total billed charges · outpatientfrom % of charges | 5 | $84.42 | $84.42 – $84.42 |
| 18 | MEDICAL CITY PLANO Plano, TX percent of total billed charges · outpatientfrom % of charges | 5 | $113.86 | $56.42 – $184.31 |
| 19 | Medical City Argyle Argyle, TX percent of total billed charges · outpatientfrom % of charges | 5 | $237.64 | $69.72 – $872.13 |
| 20 | Piney Woods Healthcare System LP Lufkin, TX facility · fee schedule · outpatient | 2 | $99.64 | $83.03 – $116.24 |
| 21 | ST. DAVID'S NORTH AUSTIN MEDICAL CENTER AUSTIN, TX percent of total billed charges · outpatientfrom % of charges | 7 | $49.95 | $23.45 – $87.72 |
| 22 | ST. DAVID'S ROUND ROCK MEDICAL CENTER ROUND ROCK, TX percent of total billed charges · outpatientfrom % of charges | 7 | $131.05 | $48.35 – $274.89 |
| 23 | ST. DAVID'S SOUTH AUSTIN MEDICAL CENTER AUSTIN, TX percent of total billed charges · outpatientfrom % of charges | 7 | $147.62 | $34.50 – $413.61 |
| 24 | TEXAS ORTHOPEDIC HOSPITAL HOUSTON, TX percent of total billed charges · outpatientfrom % of charges | 5 | $215.91 | $211.68 – $220.14 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e