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Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL

Wyoming 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 October 2026.

How much does Grafix PRIME, GrafixPL PRIME, Stravix and StravixPL cost?

$240

Typical negotiated rate. In Wyoming, October 2026.

Insurers have agreed to pay about $240 for this service. The price depends on where it is billed: about $240 from a physician practice, and about $282 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$240$151 to $282
FacilityA hospital or hospital-owned outpatient department$282$240 to $282

How much rates vary

Facilitymedian $282 · 10th to 90th $240 to $316Professionalmedian $240 · 10th to 90th $126 to $282
$200$500facility $282professional $240

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$138.04
Aetna
Setting
Professional
Modifier
None
Typical Low
$138.04
Median
$138.04
Typical High
$154.88
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$27.54
Median
$27.54
Typical High
$30.20
BCBS Wyoming
Setting
Facility
Modifier
None
Typical Low
$239.88
Median
$281.84
Typical High
$281.84
BCBS Wyoming
Setting
Professional
Modifier
None
Typical Low
$239.88
Median
$281.84
Typical High
$281.84
BCBS Wyoming
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$169.82
Median
$199.53
Typical High
$199.53
Cigna
Setting
Facility
Modifier
None
Typical Low
$190.55
Median
$302.00
Typical High
$478.63
Cigna
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$181.97
Typical High
$181.97
United
Setting
Professional
Modifier
None
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
3 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$69.18
Median
$69.18
Typical High
$75.86
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$20.89
Median
$20.89
Typical High
$22.91
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$13.80
Median
$13.80
Typical High
$15.14

Where Wyoming sits

The same service costs 2.2 times more in Alaska than in North Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Wyoming· 2nd of 51

$240

AK $257NC $117

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.