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CPT Q4133

Grafix stravix prime pl sqcm

Reported by 60 hospitals in the network under the fee schedule methodology.

Filter by billing methodology

All methodologiesAggregated across all available billing methodologies for this code.Case rateCMS definition: a flat rate for a package of items and services triggered by a diagnosis, treatment, or condition for a designated length of time.Fee scheduleCMS definition: the payer-specific negotiated charge is based on a fee schedule — for example, a Medicare, Medicaid, commercial payer, or workers’ compensation fee schedule.Per diemCMS definition: the per day charge for providing hospital items and services.Percent of billed chargesCMS definition: the payer-specific negotiated charge is based on a percentage of the total billed charges for an item or service, which may vary depending on certain pre-determined criteria being met.OtherCMS definition: used when the standard charge methodology can’t be described by case rate, fee schedule, per diem, or percent of total billed charges.

Reflects negotiated fee schedule rates with commercial payers.

National pricing summary

Low

$131

Average

$158

Median

$143

High

$484

Hospitals reporting this code

#HospitalLocation
1IHC Health Services Inc., DBA Intermountain Health Intermountain Medical CenterMurray, UT$126$134$137$160$10
2IHC Health Services Inc., DBA Intermountain Health Utah Valley HospitalProvo, UT$134$134$139$160$10
3IHC Health Services Inc., DBA Intermountain Health McKay-Dee HospitalOgden, UT$134$134$138$160$10
4Benefis Hospitals IncFalls, MT$208$208$222$369$44
5IHC Health Services Inc., DBA Intermountain Health St George Regional HospitalSt. George, UT$126$134$133$160$5
6IHC Health Services Inc., DBA Intermountain Health LDS HospitalSalt Lake City, UT$134$134$140$160$11
7Scl Health - Montana, Dba Intermountain Health St. Vincent HealthcareBillings, MT$319$404$389$432$45
8Saint Joseph Hospital, Inc. Dba Intermountain Nhealth Saint Joseph HospitalDENVER, CO$166$166$215$275$54
9IHC Health Services Inc., DBA Intermountain Health Logan Regional HospitalLogan, UT$134$134$141$324$32
10IHC Health Services Inc., DBA Intermountain Health American Fork HospitalAmerican Fork, UT$134$134$140$160$11
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