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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Idaho rates for HCPCS Q4133

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

Facilitymedian $148 · 10th–90th $117$2820%10%10th90th$148Professionalmedian $148 · 10th–90th $126$2400%20%10th90th$148$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$141.25
Typical High
$223.87
BCBS
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$208.93
Typical High
$275.42
BCBS
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$141.25
Median
$144.54
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$162.18
Typical High
$281.84
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$218.78
Typical High
$251.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$102.33
Typical High
$120.23
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$151.36
Select Health
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$302.00
Select Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$147.91
Typical High
$234.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89