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
GRAFIX PL PRIME AMNIOTIC PLACENTAL MEMBRANE 5 X 5CM ( IMPLANT QTY 25CM ) -- PS13055
Utica, NY
See all hospitals reporting HCPCS Q4133 →Price type
MVHS, Inc.’s median price of $935 is 260% above the median hospital's median price ($260), higher than 81% of the 1,822 hospitals reporting HCPCS Q4133. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 6 payers, 8 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare uhc empire plan percent of total billed charges · bothfrom % of charges | $608 | $1.3k | $1.2k | 97% | — | $84 – $3.7k |
| 2 | UnitedHealthcare uhc commercial percent of total billed charges · bothfrom % of charges | $1.1k | $1.3k | $877 | 66% | — | $154 – $2.8k |
| 3 | Aetna aetna commercial percent of total billed charges · bothfrom % of charges | $906 | $1.9k | $1.8k | 97% | — | $125 – $5.5k |
| 4 | Bcbs Ny excellus bcbs indemnity percent of total billed charges · bothfrom % of charges | $1.0k | $2.2k | $2.1k | 97% | — | $143 – $6.3k |
| 5 | Blue Cross Blue Shield excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges | $1.0k | $2.2k | $2.1k | 97% | — | $143 – $6.3k |
| 6 | Excellus excellus bcbs hmo/ppo percent of total billed charges · bothfrom % of charges | $1.0k | $2.2k | $2.1k | 97% | — | $143 – $6.3k |
| 7 | Excellus excellus bcbs indemnity percent of total billed charges · bothfrom % of charges | $1.0k | $2.2k | $2.1k | 97% | — | $143 – $6.3k |
| 8 | Humana humana hmo/pos percent of total billed charges · bothfrom % of charges | $1.1k | $2.4k | $2.3k | 97% | — | $158 – $6.9k |
Last updated: Aug 7, 2026
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