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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Ohio 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 $219 · 10th–90th $138$5620%10%20%10th90th$219Professionalmedian $138 · 10th–90th $126$2090%50%10th90th$138$2.0$10.0$50.0$200.0$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
$138.04
Median
$218.78
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$151.36
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$158.49
Typical High
$251.19
CareSource
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
CareSource
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$186.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$269.15
Typical High
$416.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$275.42
Typical High
$794.33
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$181.97
Molina
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$117.49
Typical High
$181.97
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$141.25
Typical High
$158.49
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$144.54
Typical High
$269.15
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$275.42
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$147.91