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
$93
Average
$606
Median
$127
High
$6.1k
Each hospital's average Tricare rate, under the methodology and billing class chosen below.
110 hospitals; the 90th percentile is 17.7× 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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116 hospital rates
iThe hospitals that file a Tricare 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 | $127 | $127 | — | — | — | $127 – $127 |
| 2 | AnMed Health Anderson, SC professional · fee schedule · inpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 3 | AnMed Health Anderson, SC professional · fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 4 | AnMed Health Cannon Pickens, SC professional · fee schedule · inpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 5 | AnMed Health Cannon Pickens, SC professional · fee schedule · outpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 6 | AnMed Piedmont Piedmont, SC professional · fee schedule · inpatient | 1 | $143 | $143 | — | — | — | $143 – $143 |
| 7 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 8 | Bay Park Community Hospital Oregon, OH facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 9 | Bay Park Community Hospital Oregon, OH professional · fee schedule · outpatient | 1 | $132 | $132 | — | — | — | $132 – $132 |
| 10 | Bullhead City Hospital Corporation City, AZ facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 11 | CLAIBORNE MEDICAL CENTER Tazewell, TN fee schedule · both | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 12 | CUMBERLAND MEDICAL CENTER, INC. Crossville, TN fee schedule · both | 1 | $121 | $121 | — | — | — | $121 – $121 |
| 13 | Campbell County HMA, LLC LaFollette, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 14 | Canton-Potsdam Hospital Potsdam, NY facility · fee schedule · outpatient | 1 | $109 | $109 | — | — | — | $109 – $109 |
| 15 | Carlsbad Medical Center LLC Carlsbad, NM facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 16 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 17 | Central Maine Medical Center Lewiston, ME fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 18 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $4.6k | $6.1k | $3.0k | 49% | — | $2.2k – $11.3k |
| 19 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 20 | Cocke County HMA, LLC Newport, TN facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 21 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $809 | $1.5k | $1.3k | 89% | — | $342 – $4.2k |
| 22 | Crestview Hospital Corporation Crestview, FL facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 23 | Doylestown Hospital Doylestown, PA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 24 | East Georgia Regional Medical Center LLC Statesboro, GA facility · fee schedule · outpatient | 1 | $127 | $127 | — | — | — | $127 – $127 |
| 25 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $127 | $845 | $1.6k | 190% | — | $127 – $4.4k |
← Payers reporting HCPCS Q4133 · Snapshot 20261111T120946Z-9134e7f7