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
GAUZE, XEROFORM 5" X 9" / 8884
Low
$0
Average
$15
Median
$5
High
$161
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
55 payers; the 90th percentile is 13.4× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Wellmark case rate · outpatient · +1 other terms | 13 | $3 | $4 | $1 | 33% | 2–20 | $2 – $7 |
| 2 | UnitedHealthcare fee schedule · outpatient · +19 other terms | 311 | $3 | $3 | $2 | 50% | — | $1 – $40 |
| 3 | Humana fee schedule · outpatient · +15 other terms | 308 | $3 | $5 | $5 | 104% | — | $1 – $27 |
| 4 | Aetna fee schedule · outpatient · +19 other terms | 282 | $3 | $4 | $3 | 66% | — | $1 – $40 |
| 5 | Blue Cross Blue Shield fee schedule · outpatient · +15 other terms | 204 | $4 | $4 | $4 | 82% | — | $0 – $66 |
| 6 | WellCare fee schedule · outpatient · +8 other terms | 185 | $4 | $4 | $1 | 16% | — | $3 – $7 |
| 7 | Devoted fee schedule · outpatient · +5 other terms | 162 | $3 | $3 | $0 | 2% | — | $3 – $4 |
| 8 | Cigna Healthspring fee schedule · outpatient · +2 other terms | 116 | $4 | $4 | $0 | 3% | — | $3 – $4 |
| 9 | Molina fee schedule · outpatient · +12 other terms | 96 | $5 | $5 | $2 | 39% | — | $3 – $9 |
| 10 | Cigna fee schedule · outpatient · +17 other terms | 84 | $4 | $4 | $3 | 80% | — | $3 – $39 |
| 11 | Anthem fee schedule · outpatient · +13 other terms | 76 | $3 | $3 | $1 | 48% | — | $0 – $12 |
| 12 | Kaiser fee schedule · outpatient · +9 other terms | 42 | $3 | $4 | $1 | 26% | — | $3 – $8 |
| 13 | Superior Healthplan fee schedule · outpatient | 40 | $4 | $4 | $0 | 1% | — | $3 – $4 |
| 14 | Clover fee schedule · outpatient · +1 other terms | 37 | $3 | $4 | $0 | 3% | — | $3 – $4 |
| 15 | Bcbs Tx fee schedule · outpatient · +3 other terms | 31 | $3 | $3 | $1 | 29% | — | $2 – $12 |
| 16 | Optum fee schedule · outpatient · +6 other terms | 25 | $3 | $4 | $2 | 42% | — | $3 – $9 |
| 17 | Oscar fee schedule · outpatient · +5 other terms | 25 | $3 | $4 | $0 | 4% | — | $3 – $4 |
| 18 | Caresource facility · case rate · outpatient · +5 other terms | 20 | $15 | $14 | $6 | 45% | — | $3 – $27 |
| 19 | Medicare fee schedule · outpatient · +5 other terms | 18 | $3 | $3 | $0 | 1% | — | $3 – $3 |
| 20 | Ambetter facility · fee schedule · outpatient · +7 other terms | 17 | $5 | $5 | $2 | 32% | — | $0 – $6 |
| 21 | Amerihealth Caritas fee schedule · outpatient · +3 other terms | 16 | $4 | $4 | $0 | 2% | — | $4 – $4 |
| 22 | Highmark facility · fee schedule · outpatient · +5 other terms | 15 | $7 | $8 | $5 | 60% | — | $3 – $32 |
| 23 | Medica fee schedule · outpatient · +9 other terms | 15 | $7 | $7 | $1 | 22% | — | $4 – $9 |
| 24 | Aetna Better Health fee schedule · outpatient · +5 other terms | 14 | $3 | $3 | $1 | 41% | — | $2 – $7 |
| 25 | Bcbs Mn fee schedule · outpatient · +4 other terms | 12 | $3 | $2 | $1 | 65% | — | $0 – $4 |
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