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 NON-IMPREG STER MORE THAN 16-<=48 SQ IN WO
Low
$0
Average
$142
Median
$1
High
$3.8k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
51 payers; the 90th percentile is 480.2× 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.
Filter by billing methodology
Filter by billing class
| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +19 other terms | 302 | $1 | $7 | $26 | 393% | — | $0 – $122 |
| 2 | Humana fee schedule · outpatient · +16 other terms | 301 | $1 | $1 | $1 | 109% | — | $0 – $5 |
| 3 | Aetna fee schedule · outpatient · +17 other terms | 267 | $1 | $1 | $5 | 381% | — | $0 – $46 |
| 4 | Blue Cross Blue Shield fee schedule · outpatient · +14 other terms | 187 | $1 | $1 | $0 | 47% | — | $0 – $3 |
| 5 | WellCare fee schedule · outpatient · +5 other terms | 185 | $1 | $1 | $0 | 16% | — | $1 – $1 |
| 6 | Devoted fee schedule · outpatient · +4 other terms | 163 | $1 | $1 | $0 | 2% | — | $1 – $1 |
| 7 | Cigna Healthspring fee schedule · outpatient · +2 other terms | 116 | $1 | $1 | $0 | 3% | — | $1 – $1 |
| 8 | Molina fee schedule · outpatient · +10 other terms | 97 | $1 | $1 | $4 | 397% | — | $0 – $63 |
| 9 | Cigna fee schedule · outpatient · +14 other terms | 78 | $1 | $1 | $3 | 304% | — | $1 – $25 |
| 10 | Anthem fee schedule · outpatient · +12 other terms | 74 | $1 | $1 | $0 | 21% | — | $1 – $1 |
| 11 | Kaiser fee schedule · outpatient · +5 other terms | 40 | $1 | $1 | $4 | 324% | — | $1 – $25 |
| 12 | Superior Healthplan fee schedule · outpatient | 40 | $1 | $1 | — | — | — | $1 – $1 |
| 13 | Clover fee schedule · outpatient · +1 other terms | 37 | $1 | $1 | $0 | 3% | — | $1 – $1 |
| 14 | Bcbs Tx fee schedule · outpatient | 31 | $1 | $1 | $0 | 30% | — | $0 – $2 |
| 15 | Caresource fee schedule · outpatient · +6 other terms | 30 | $1 | $89 | $54 | 61% | — | $1 – $122 |
| 16 | Optum fee schedule · outpatient · +5 other terms | 25 | $1 | $1 | $0 | 42% | — | $1 – $1 |
| 17 | Oscar fee schedule · outpatient · +3 other terms | 24 | $1 | $1 | $0 | 3% | — | $1 – $1 |
| 18 | Medicare fee schedule · outpatient · +3 other terms | 18 | $1 | $1 | — | — | — | $1 – $1 |
| 19 | Ambetter facility · fee schedule · outpatient · +7 other terms | 17 | $1 | $1 | $0 | 37% | — | $0 – $1 |
| 20 | Amerihealth Caritas fee schedule · outpatient · +2 other terms | 16 | $1 | $1 | $0 | 3% | — | $1 – $1 |
| 21 | Aetna Better Health fee schedule · outpatient · +4 other terms | 13 | $0 | $0 | $0 | 35% | — | $0 – $1 |
| 22 | Wellmark fee schedule · both · +1 other terms | 13 | $1 | $1 | — | — | — | $1 – $1 |
| 23 | Bcbs Mn fee schedule · outpatient · +4 other terms | 12 | $1 | $1 | $0 | 55% | — | $0 – $1 |
| 24 | Bcbs Nj fee schedule · outpatient | 12 | $1 | $1 | $1 | 67% | — | $1 – $3 |
| 25 | Highmark fee schedule · outpatient · +4 other terms | 10 | $1 | $1 | $0 | 35% | — | $0 – $1 |
← Hospitals reporting HCPCS A6403 · Snapshot 20261111T120946Z-9134e7f7