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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Montana 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?

$155

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $155 for this service. The price depends on where it is billed: about $155 from a physician practice, and about $158 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$155$126 to $178
FacilityA hospital or hospital-owned outpatient department$158$155 to $209

How much rates vary

Facilitymedian $158 · 10th to 90th $126 to $407Professionalmedian $155 · 10th to 90th $79 to $209
$100$200$500facility $158professional $155

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
Professional
Modifier
None
Typical Low
$138.04
Median
$144.54
Typical High
$223.87
BCBS Montana
Setting
Facility
Modifier
None
Typical Low
$426.58
Median
$501.19
Typical High
$537.03
Cigna
Setting
Facility
Modifier
None
Typical Low
$154.88
Median
$204.17
Typical High
$407.38
Cigna
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$125.89
Median
$158.49
Typical High
$208.93
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$141.25
Typical High
$158.49
Providence
Setting
Facility
Modifier
None
Typical Low
$154.88
Median
$204.17
Typical High
$407.38
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$154.88
Typical High
$208.93
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89

Where Montana 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.

Montana· 7th of 51

$155

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.