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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Wisconsin 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 $251 · 10th–90th $135$6460%20%10th90th$251Professionalmedian $151 · 10th–90th $126$3090%50%10th90th$151$5.0$20.0$100.0$500.0$2.0K

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
$144.54
Median
$251.19
Typical High
$645.65
Aetna
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$144.54
Typical High
$251.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$218.78
Typical High
$416.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$199.53
Median
$389.05
Typical High
$562.34
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$173.78
Typical High
$269.15
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$309.03
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$141.25
Typical High
$616.60
Medica
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$288.40
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$58.88
Typical High
$154.88
Network Health
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Network Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$147.91
Typical High
$234.42
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$138.04
Typical High
$309.03
Quartz
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$263.03
Typical High
$416.87
Quartz
Setting
Facility
Modifier
Global
Typical Low
$489.78
Median
$489.78
Typical High
$707.95
Quartz
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$165.96
Typical High
$1,445.44
Security Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$186.21
Typical High
$229.09
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$295.12
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$173.78