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 Wellmark 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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63 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · both | 3 | $220.00 | $220.00 – $220.00 |
| 2 | Allen Memorial Hospital Corporation Waterloo, IA fee schedule · outpatient | 3 | $220.00 | $220.00 – $220.00 |
| 3 | Central Community Hospital Elkader, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $155.17 | $102.70 – $196.28 |
| 4 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · both | 3 | $220.00 | $220.00 – $220.00 |
| 5 | Central Iowa Hospital Corporation Des Moines, IA fee schedule · outpatient | 3 | $220.00 | $220.00 – $220.00 |
| 6 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · both | 3 | $220.00 | $220.00 – $220.00 |
| 7 | Central Iowa Hospital Corporation West Des Moines, IA fee schedule · outpatient | 3 | $220.00 | $220.00 – $220.00 |
| 8 | Diley Ridge Medical Center Canal Winchester, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $202.29 | $123.52 – $283.09 |
| 9 | Grinnell Regional Medical Center Grinnell, IA fee schedule · both | 3 | $220.00 | $220.00 – $220.00 |
| 10 | Grinnell Regional Medical Center Grinnell, IA fee schedule · outpatient | 3 | $220.00 | $220.00 – $220.00 |
| 11 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $287.14 | $188.58 – $367.07 |
| 12 | Holy Cross Hospital-Ft. Lauderdale Ft. Lauderdale, FL facility · per diem · both | 1 | $763.00 | $763.00 – $763.00 |
| 13 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $222.63 | $138.10 – $305.89 |
| 14 | Johnson Memorial Hospital Stafford Springs, CT facility · percent of total billed charges · bothfrom % of charges | 1 | $193.95 | $118.42 – $271.42 |
| 15 | Mercy Fitzgerald Hospital Darby, PA facility · percent of total billed charges · bothfrom % of charges | 1 | $533.36 | $325.66 – $746.41 |
| 16 | Mercy Health Hackley Campus Muskogen, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $141.91 | $86.65 – $198.60 |
| 17 | Mercy Health Lakeshore Campus Shelby, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $248.65 | $151.82 – $347.97 |
| 18 | Mercy Health Saint Marys Rockford, MI facility · percent of total billed charges · bothfrom % of charges | 1 | $153.20 | $100.22 – $196.89 |
| 19 | Mercy Hospital of Franciscan Sisters Inc Oelwein, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $122.33 | $80.97 – $154.75 |
| 20 | Mercy Medical Center - Dyersville Dyersville, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $167.11 | $110.61 – $211.38 |
| 21 | Mercy Medical Center - New Hampton New Hampton, IA facility · percent of total billed charges · bothfrom % of charges | 1 | $134.37 | $82.05 – $188.05 |
| 22 | Mishawaka Medical Center Mishawaka, IN facility · percent of total billed charges · bothfrom % of charges | 1 | $140.20 | $85.61 – $196.21 |
| 23 | Mount Carmel East Reynoldsburg, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $231.18 | $141.16 – $323.53 |
| 24 | Mount Carmel Grove City Grove City, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $231.18 | $141.16 – $323.53 |
| 25 | Mount Carmel New Albany Surgical Hospital New Albany, OH facility · percent of total billed charges · bothfrom % of charges | 1 | $231.18 | $141.16 – $323.53 |
← Payers reporting HCPCS A2007 · Snapshot 20261109T115250Z-6452cf6e