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
$84
Median
$16
High
$1.9k
Each hospital's average First Health rate, under the methodology and billing class chosen below.
57 hospitals; the 90th percentile is 77.4× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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75 hospital rates
iThe hospitals that file a First Health 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.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | AHS Cushing Hospital, LLC Cushing, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $10 | $10 | $1 | 12% | — | $9 – $11 |
| 2 | AHS Henryetta Hospital, LLC Henryetta, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $9 | $10 | $2 | 17% | — | $7 – $12 |
| 3 | AHS Pryor Hospital, LLC Pryor, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 4 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · inpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 5 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 6 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 7 | Bristol Regional Medical Center BRISTOL, VA percent of total billed charges · bothfrom % of charges | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 8 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 9 | Davis Medical Center Elkins, WV professional · fee schedule · both | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 10 | Ephrata Community Hospital Ephrata, PA percent of total billed charges · outpatientfrom % of charges | 1 | $55 | $55 | — | — | — | $55 – $55 |
| 11 | Greeneville Community Hospital GREENEVILLE, TN percent of total billed charges · bothfrom % of charges | 1 | $147 | $147 | — | — | — | $147 – $147 |
| 12 | HOLLAND COMMUNITY HOSPITAL Holland, MI percent of total billed charges · outpatientfrom % of charges | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 13 | Hackensack Meridian Mountainside Medical Center Montclair, NJ facility · percent of total billed charges · bothfrom % of charges | 2 | $2 | $2 | $0 | 7% | — | $2 – $2 |
| 14 | Hawkins County Memorial Hospital ROGERSVILLE, TN percent of total billed charges · bothfrom % of charges | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 15 | Holston Valley Medical Center KINGSPORT, TN percent of total billed charges · bothfrom % of charges | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 16 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $14 | $15 | $3 | 18% | — | $12 – $20 |
| 17 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 18 | Lonesome Pine Hospital NORTON, VA percent of total billed charges · bothfrom % of charges | 1 | $166 | $166 | — | — | — | $166 – $166 |
| 19 | MADISON ST JOSEPH HEALTH CENTER Madisonville, TX fee schedule · inpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 20 | MADISON ST JOSEPH HEALTH CENTER Madisonville, TX fee schedule · outpatient | 1 | $7 | $7 | — | — | — | $7 – $7 |
| 21 | Marshfield Medical Center - Dickinson Iron Mountain, MI facility · percent of total billed charges · inpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 22 | Marshfield Medical Center - Dickinson Iron Mountain, MI facility · percent of total billed charges · outpatientfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 23 | MedStar Georgetown Hospital Washington, DC facility · percent of total billed charges · inpatientfrom % of charges | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 24 | MedStar Georgetown Hospital Washington, DC facility · percent of total billed charges · outpatientfrom % of charges | 1 | $160 | $160 | — | — | — | $160 – $160 |
| 25 | MedStar Washington Hospital Center NW, WA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $100 | $100 | — | — | — | $100 – $100 |
← Payers reporting HCPCS A6223 · Snapshot 20261111T120946Z-9134e7f7