go back

Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Pennsylvania 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 $234 · 10th–90th $126$5,0120%20%10th90th$234Professionalmedian $138 · 10th–90th $126$1660%50%10th90th$138$100.0$500.0$2.0K$10.0K$50.0K

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
$74.13
Median
$190.55
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$144.54
AmeriHealth
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$22,387.21
Typical High
$165,958.69
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$208.93
Typical High
$8,511.38
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$208.93
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$446.68
Typical High
$478.63
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$239.88
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$151.36
Typical High
$218.78
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$346.74
Typical High
$363.08
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Independence Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$23,442.29
Typical High
$158,489.32
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$234.42
Typical High
$1,202.26
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$141.25
Typical High
$165.96
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$154.88
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$154.88
Typical High
$154.88
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$190.55