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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Utah 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 $182 · 10th–90th $162$3890%20%40%10th90th$182Professionalmedian $141 · 10th–90th $126$1740%20%10th90th$141$50.0$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
$162.18
Median
$389.05
Typical High
$389.05
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$151.36
Typical High
$173.78
Cigna
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$194.98
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$107.15
Typical High
$181.97
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$177.83
Select Health
Setting
Facility
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$120.23
Typical High
$154.88
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$169.82
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89