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
$187
Median
$3
High
$4.7k
Each hospital's average First Health rate, under the methodology and billing class chosen below.
28 hospitals; the 90th percentile is 5898.3× 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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30 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 | Bexar County Hospital District San Antonio, TX fee schedule · outpatient | 1 | $1 | $1 | — | — | — | $1 – $1 |
| 2 | Broaddus Hospital Association Inc Philippi, WV professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 3 | Davis Medical Center Elkins, WV professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 4 | Deaconess Health System Gibson General Hospital Princeton, IN professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 5 | Deaconess Health System Henderson Hospital Henderson, KY professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 6 | Deaconess Health System Union County Hospital Morganfield, KY professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 7 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 8 | Deaconess Hospital, Inc Newburgh, IN professional · fee schedule · both | 1 | $0 | $0 | — | — | — | $0 – $0 |
| 9 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL professional · percent of total billed charges · bothfrom % of charges | 1 | $4 | $4 | — | — | — | $4 – $4 |
| 10 | FHN Memorial Hospital Freeport, IL percent of total billed charges · outpatientfrom % of charges | 1 | $2 | $2 | — | — | — | $2 – $2 |
| 11 | Hospital Authority of Colquitt County Moultrie, GA fee schedule · both | 1 | $14 | $14 | $1 | 4% | — | $13 – $14 |
| 12 | Lowell General Hospital Lowell, MA percent of total billed charges · bothfrom % of charges | 1 | $229 | $229 | — | — | — | $229 – $229 |
| 13 | Mayo Clinic Florida Jacksonville, FL facility · percent of total billed charges · bothfrom % of charges | 2 | $4.7k | $4.7k | $1.0k | 22% | — | $3.6k – $5.9k |
| 14 | Pemiscot Memorial Health System Hayti, MO percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | $0 | 34% | — | $1 – $2 |
| 15 | ST FRANCIS HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Litchfield, IL percent of total billed charges · bothfrom % of charges | 1 | $21 | $21 | — | — | — | $21 – $21 |
| 16 | ST MARYS HOSPITAL DECATUR OF HOSPITAL SISTERS OF THE THIRD ORDER OF ST FRANCIS Chatham, IL percent of total billed charges · bothfrom % of charges | 1 | $16 | $16 | — | — | — | $16 – $16 |
| 17 | St Luke's Magic Valley Regional Medical Center, LTD Jerome, ID percent of total billed charges · bothfrom % of charges | 2 | $21 | $21 | $1 | 6% | — | $20 – $22 |
| 18 | St Luke's McCall, LTD McCall, ID percent of total billed charges · bothfrom % of charges | 1 | $22 | $22 | — | — | — | $22 – $22 |
| 19 | St Luke's Nampa Medical Center, LTD Nampa, ID percent of total billed charges · bothfrom % of charges | 2 | $19 | $19 | $0 | 2% | — | $19 – $20 |
| 20 | St Luke's Regional Medical Center, LTD Mountain Home, ID percent of total billed charges · bothfrom % of charges | 2 | $19 | $19 | $0 | 2% | — | $19 – $20 |
| 21 | St Luke's Wood River Medical Center, LTD Ketchum, ID percent of total billed charges · bothfrom % of charges | 2 | $22 | $22 | $0 | 1% | — | $22 – $22 |
| 22 | SwedishAmerican Hospital IL 61104; 1625 S State St Belvidere, IL percent of total billed charges · bothfrom % of charges | 1 | $80 | $80 | $71 | 88% | — | $9 – $150 |
| 23 | Texas Children's Hospital The Woodlands, TX facility · percent of total billed charges · inpatientfrom % of charges | 2 | $0 | $0 | $0 | 8% | — | $0 – $0 |
| 24 | Texas Children's Hospital The Woodlands, TX facility · percent of total billed charges · outpatientfrom % of charges | 3 | $0 | $0 | $0 | 40% | — | $0 – $0 |
| 25 | Texas Children's Hospital - Austin Austin, TX facility · percent of total billed charges · inpatientfrom % of charges | 2 | $0 | $0 | $0 | 8% | — | $0 – $0 |
← Payers reporting HCPCS A6403 · Snapshot 20261111T120946Z-9134e7f7