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
HC GRAFIX PRIME PER 1SQ CM Q4133 (HIGH)
Low
$1
Average
$132
Median
$133
High
$350
Each hospital's average Clover rate, under the methodology and billing class chosen below.
55 hospitals; the 90th percentile is 1.7× 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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55 hospital rates
iThe hospitals that file a Clover 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 | Affinity Hospital LLC Birmingham, AL facility · fee schedule · outpatient | 1 | $115 | $115 | — | — | — | $115 – $115 |
| 2 | Conway Hospital, Inc. Conway, SC professional · fee schedule · outpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 3 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · both | 2 | $120 | $120 | — | — | — | $120 – $120 |
| 4 | East Georgia Regional Medical Center LLC Statesboro, GA facility · fee schedule · outpatient | 1 | $117 | $117 | — | — | — | $117 – $117 |
| 5 | Fox Chase Cancer Center Philadelphia, PA facility · fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 6 | Gadsden Regional Medical Center LLC Gadsden, AL facility · fee schedule · outpatient | 1 | $113 | $113 | — | — | — | $113 – $113 |
| 7 | Grady Memorial Hospital Atlanta, GA professional · fee schedule · outpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 8 | HMH HOSPITALS CORPORATION Hackensack, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 9 | HMH HOSPITALS CORPORATION Red Bank, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 10 | HMH HOSPITALS CORPORATION Edison, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 11 | HMH HOSPITALS CORPORATION Manahawkin, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 12 | HMH HOSPITALS CORPORATION Brick, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 13 | HMH HOSPITALS CORPORATION Neptune City, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 14 | HMH HOSPITALS CORPORATION Edison, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 15 | HMH HOSPITALS CORPORATION North Bergen, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 16 | HMH HOSPITALS CORPORATION Holmdel, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1 | $1 | $0 | 52% | — | $0 – $2 |
| 17 | HMH HOSPITALS CORPORATION Old Bridge, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 18 | HMH HOSPITALS CORPORATION Point Pleasant, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 19 | HMH HOSPITALS CORPORATION Perth Amboy, NJ facility · percent of total billed charges · outpatientfrom % of charges | 1 | $74 | $88 | $46 | 53% | — | $41 – $199 |
| 20 | Hilton Head Medical Center LLC Hilton Head Island, SC fee schedule · both | 2 | $120 | $120 | — | — | — | $120 – $120 |
| 21 | Inspira Health Center Bridgeton Bridgeton, NJ fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 22 | Inspira Health Center Woodbury Woodbury, NJ fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 23 | Inspira Medical Center Elmer Elmer, NJ fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 24 | Inspira Medical Center Mannington Salem, NJ fee schedule · outpatient | 1 | $136 | $136 | — | — | — | $136 – $136 |
| 25 | Inspira Medical Center Mullica Hill Hill, NJ fee schedule · outpatient | 1 | $140 | $140 | — | — | — | $140 – $140 |
← Payers reporting HCPCS Q4133 · Snapshot 20261111T120946Z-9134e7f7