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
$2
Average
$17
Median
$8
High
$150
Each hospital's average Phcs rate, under the methodology and billing class chosen below.
34 hospitals; the 90th percentile is 6.2× 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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49 hospital rates
iThe hospitals that file a Phcs 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 | $11 | $11 | $0 | 3% | — | $11 – $11 |
| 2 | AHS Henryetta Hospital, LLC Henryetta, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $10 | $10 | $1 | 13% | — | $9 – $12 |
| 3 | AHS Hillcrest Medical Center, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $14 | $14 | $1 | 8% | — | $12 – $15 |
| 4 | AHS Southcrest Hospital, LLC Tulsa, OK facility · percent of total billed charges · bothfrom % of charges | 2 | $10 | $10 | $0 | 3% | — | $10 – $10 |
| 5 | ALEGENT CREIGHTON HEALTH Papillion, NE fee schedule · inpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 6 | ALEGENT CREIGHTON HEALTH Papillion, NE fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 7 | ALEGENT CREIGHTON HEALTH Omaha, NE fee schedule · inpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 8 | ALEGENT CREIGHTON HEALTH Omaha, NE fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 9 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Council Bluffs, IA fee schedule · inpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 10 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Council Bluffs, IA fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 11 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Omaha, NE fee schedule · inpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 12 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Omaha, NE fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 13 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Omaha, NE fee schedule · inpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 14 | ALEGENT HEALTH BERGAN MERCY HEALTH SYSTEM Omaha, NE fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 15 | ALEGENT HEALTH IMMANUEL MEDICAL CENTER Omaha, NE fee schedule · inpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 16 | ALEGENT HEALTH IMMANUEL MEDICAL CENTER Omaha, NE fee schedule · outpatient | 1 | $6 | $6 | — | — | — | $6 – $6 |
| 17 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · inpatientfrom % of charges | 1 | $2 | $4 | $4 | 90% | — | $1 – $12 |
| 18 | AMH Cath Labs LLC Arlington, TX percent of total billed charges · outpatientfrom % of charges | 1 | $2 | $4 | $3 | 90% | — | $1 – $11 |
| 19 | Athens Hospital, LLC Athens, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $12 | $12 | $2 | 18% | — | $9 – $14 |
| 20 | BSA Hospital Amarillo, TX facility · percent of total billed charges · bothfrom % of charges | 2 | $17 | $17 | — | — | — | $17 – $17 |
| 21 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · inpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 22 | BURLESON ST. JOSEPH HEALTH CENTER OF CALDWELL, TEXAS Caldwell, TX fee schedule · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 23 | Boulder Community Health Lafayette, CO professional · fee schedule · both | 1 | $5 | $5 | — | — | — | $5 – $5 |
| 24 | Carthage Hospital, LLC Carthage, TX facility · percent of total billed charges · bothfrom % of charges | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 25 | Hackensack Meridian Mountainside Medical Center Montclair, NJ facility · percent of total billed charges · bothfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
← Payers reporting HCPCS A6223 · Snapshot 20261111T120946Z-9134e7f7