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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Washington 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 $209 · 10th–90th $126$4370%10%20%10th90th$209Professionalmedian $141 · 10th–90th $126$2630%20%40%10th90th$141$50.0$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
$63.10
Median
$151.36
Typical High
$151.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$141.25
Typical High
$251.19
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$275.42
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$134.90
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$323.59
Typical High
$562.34
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$281.84
Typical High
$380.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$138.04
Typical High
$194.98
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$138.04
Typical High
$173.78
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$131.83
Typical High
$234.42
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$102.33
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$141.25
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$295.12