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
$3
High
$102
Each hospital's average UnitedHealthcare rate, under the methodology and billing class chosen below.
536 hospitals; the 90th percentile is 5.2× 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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639 hospital rates
iThe hospitals that file a UnitedHealthcare 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 | Connecticut Children's Hartford, CT percent of total billed charges · bothfrom % of charges | 1 | $1 | $1 | $0 | 5% | 44 | $1 – $1 |
| 2 | University of Wisconsin Hospital and Clinics Authority WI 53718; 1675 Highland Ave Madison, WI percent of total billed chargesfrom % of charges | 3 | $2 | $2 | $0 | 16% | 26 | $2 – $3 |
| 3 | Aurora Medical Center Sheboygan County Sheboygan, WI percent of total billed charges · outpatientfrom % of charges | 5 | $2 | $3 | $2 | 93% | 20–200 | $1 – $8 |
| 4 | CHRISTUS Hospital - Orange Orange, TX percent of total billed charges · outpatientfrom % of charges | 1 | $25 | $25 | — | — | 18 | $25 – $25 |
| 5 | CHRISTUS West Beaumont Beaumont, TX percent of total billed charges · outpatientfrom % of charges | 1 | $25 | $25 | — | — | 18 | $25 – $25 |
| 6 | Christus Health Southeast Texas Beaumont, TX percent of total billed charges · outpatientfrom % of charges | 1 | $25 | $25 | — | — | 18 | $25 – $25 |
| 7 | Christus Health Southeast Texas Port Arthur, TX percent of total billed charges · outpatientfrom % of charges | 1 | $25 | $25 | — | — | 18 | $25 – $25 |
| 8 | Southeast Texas Orthopedic Specialty Center Port Arthur, TX percent of total billed charges · outpatientfrom % of charges | 1 | $25 | $25 | — | — | 18 | $25 – $25 |
| 9 | Aurora Medical Center Washington County Hartford, WI percent of total billed charges · outpatientfrom % of charges | 5 | $2 | $3 | $2 | 62% | 5–50 | $2 – $8 |
| 10 | SwedishAmerican Hospital IL 61104; 1625 S State St Belvidere, IL percent of total billed charges · bothfrom % of charges | 1 | $16 | $108 | $196 | 181% | 5–50 | $6 – $615 |
| 11 | Aurora Medical Center Summit Summit, WI percent of total billed charges · outpatientfrom % of charges | 5 | $2 | $3 | $2 | 85% | 4–40 | $1 – $8 |
| 12 | Aurora Sinai Medical Center of Aurora Health Care Metro Inc Milwaukee, WI percent of total billed charges · outpatientfrom % of charges | 5 | $2 | $3 | $2 | 75% | 4–40 | $1 – $8 |
| 13 | Aurora Medical Center Oshkosh Oshkosh, WI percent of total billed charges · outpatientfrom % of charges | 5 | $1 | $3 | $3 | 85% | 3–30 | $1 – $8 |
| 14 | Holy Redeemer Health System Meadowbrook, PA facility · other · outpatient | 1 | $73 | $73 | — | — | 3–30 | $73 – $73 |
| 15 | St Luke's Regional Medical Center, LTD Mountain Home, ID percent of total billed charges · bothfrom % of charges | 1 | $2 | $2 | — | — | 3–30 | $2 – $2 |
| 16 | St Luke's Wood River Medical Center, LTD Ketchum, ID percent of total billed charges · bothfrom % of charges | 2 | $2 | $2 | $0 | 21% | 3–30 | $1 – $2 |
| 17 | Aurora Medical Center Fond du Lac Fond Du Lac, WI percent of total billed charges · outpatientfrom % of charges | 5 | $4 | $4 | $3 | 75% | 2–20 | $1 – $8 |
| 18 | Shannon Medical Center San Angelo, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | — | — | 2–20 | $22 – $22 |
| 19 | Shannon Medical Center Big Spring Big Spring, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | — | — | 2–20 | $22 – $22 |
| 20 | Shannon River Crest Hospital San Angelo, TX facility · percent of total billed charges · outpatientfrom % of charges | 1 | $22 | $22 | — | — | 2–20 | $22 – $22 |
| 21 | Arkansas Childrens Northwest Springdale, AR facility · percent of total billed charges · outpatientfrom % of charges | 1 | $2 | $2 | — | — | 1–10 | $2 – $2 |
| 22 | ACADIAN MEDICAL CENTER EUNICE, LA percent of total billed charges · bothfrom % of charges | 2 | $0 | $0 | — | — | — | $0 – $0 |
| 23 | ADVENTIST HEALTH MEDICAL CENTER TEHACHAPI Tehachapi, CA fee schedule · outpatient | 3 | $1 | $2 | $1 | 44% | — | $1 – $3 |
| 24 | ADVENTIST HEALTH MENDOCINO COAST Bragg, CA fee schedule · outpatient | 3 | $1 | $2 | $1 | 45% | — | $1 – $3 |
| 25 | AHS Cushing Hospital, LLC Cushing, OK facility · percent of total billed charges · bothfrom % of charges | 1 | $6 | $6 | — | — | — | $6 – $6 |
← Payers reporting HCPCS A6223 · Snapshot 20261112T124536Z-e251e855