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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Minnesota 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 October 2026.

How much does Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL cost?

$145

Typical negotiated rate. In Minnesota, October 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $257 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$145$138 to $191
FacilityA hospital or hospital-owned outpatient department$257$145 to $316

How much rates vary

Facilitymedian $257 · 10th to 90th $135 to $437Professionalmedian $145 · 10th to 90th $126 to $234
$100$200$500$1Kfacility $257professional $145

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Aetna
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$144.54
Typical High
$144.54
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$257.04
Typical High
$275.42
BCBS Minnesota
Setting
Professional
Modifier
None
Typical Low
$123.03
Median
$194.98
Typical High
$239.88
Cigna
Setting
Facility
Modifier
None
Typical Low
$208.93
Median
$331.13
Typical High
$512.86
Cigna
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$147.91
Typical High
$177.83
Health Partners
Setting
Facility
Modifier
None
Typical Low
$186.21
Median
$302.00
Typical High
$512.86
Health Partners
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Medica
Setting
Facility
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$257.04
Medica
Setting
Professional
Modifier
None
Typical Low
$134.90
Median
$134.90
Typical High
$1,445.44
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$186.21
9 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Facility
Modifier
52 · Reduced service
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
Aetna
Setting
Facility
Modifier
53 · Discontinued
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Facility
Modifier
55 · Aftercare only
Typical Low
$21.88
Median
$21.88
Typical High
$21.88
Aetna
Setting
Facility
Modifier
56 · Pre-op care only
Typical Low
$14.45
Median
$14.45
Typical High
$14.45
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$70.79
Median
$72.44
Typical High
$72.44
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$28.84
Median
$28.84
Typical High
$28.84
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$21.38
Median
$21.88
Typical High
$21.88
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$14.45
Median
$14.45
Typical High
$14.45
BCBS Minnesota
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$81.28
Median
$125.89
Typical High
$134.90

Where Minnesota sits

The same service costs 2.2 times more in Alaska than in North Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Minnesota· 13th of 51

$145

AK $257NC $117

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.