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
$6
Median
$8
High
$15
Each hospital's average Medicaid rate, under the methodology and billing class chosen below.
13 hospitals; the 90th percentile is 7.1× 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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14 hospital rates
iThe hospitals that file a Medicaid 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 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 6 | $1 | $1 | $1 | 69% | — | $0 – $2 |
| 2 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 3 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 4 | CATHOLIC HEALTH INITIATIVES COLORADO Salt Lake City, UT fee schedule · outpatient | 1 | $3 | $3 | — | — | — | $3 – $3 |
| 5 | Childrens Hospital of Los Angeles Angeles, CA facility · other · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 6 | Childrens Hospital of Los Angeles Angeles, CA professional · fee schedule · outpatient | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 7 | Clarion Hospital Clarion, PA facility · case rate · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 8 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $14 | $15 | $3 | 18% | — | $12 – $20 |
| 9 | LODI MEMORIAL HOSPITAL ASSOCIATION INC Lodi, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 10 | REEDLEY COMMUNITY HOSPITAL Reedley, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 11 | SONORA COMMUNITY HOSPITAL Sonora, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 12 | UKIAH ADVENTIST HOSPITAL Ukiah, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 13 | UNIVERSITY OF MICHIGAN HEALTH Ann Arbor, MI facility · fee schedule · outpatient | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 14 | WILLITS HOSPITAL INC Willits, CA fee schedule · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
← Payers reporting HCPCS A6223 · Snapshot 20261111T120946Z-9134e7f7