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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

New Hampshire 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 $145 · 10th–90th $132$3240%20%40%10th90th$145Professionalmedian $138 · 10th–90th $126$1660%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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$138.04
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$165.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$251.19
Typical High
$338.84
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
$223.87
United
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$147.91
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$295.12
Typical High
$323.59