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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Michigan 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 $302 · 10th–90th $102$1,0000%20%10th90th$302Professionalmedian $138 · 10th–90th $126$1510%50%10th90th$138$20.0$50.0$100.0$200.0$500.0$1.0K

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
$144.54
Median
$933.25
Typical High
$1,000.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$21.88
Typical High
$125.89
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$125.89
Typical High
$131.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$144.54
Typical High
$144.54
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$302.00
Typical High
$812.83
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$147.91
Typical High
$371.54
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$281.84
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$147.91