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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Maine 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 $513 · 10th–90th $145$5130%50%10th$513Professionalmedian $138 · 10th–90th $126$1450%50%10th90th$138$100.0$200.0$500.0

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$707.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$144.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$363.08
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$141.25
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$138.04
Typical High
$204.17
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$138.04