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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

South Dakota 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 $138 · 10th–90th $135$2820%50%10th90th$138Professionalmedian $138 · 10th–90th $135$2400%50%10th90th$138$100.0$200.0$500.0$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
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$234.42
Avera
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$138.04
Typical High
$144.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$229.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$173.78
Medica
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$229.09
Typical High
$281.84
Medica
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$1,445.44
Midlands
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$204.17
Typical High
$204.17
Midlands
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$165.96
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$239.88
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$138.04