HCPCS Q4133
Grafix prime, grafixpl prime, stravix and stravixpl, per square centimeter (add-on, list separately in addition to primary procedure)
Current codeSkin Substitute Products42 hospitals with prices
What Washington hospitals publish for this code
Other government program: TRICARE, VA, Indian Health Service, workers' compensation, or another public program.
| Hospital | Other government program rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | — | $1,246 – $6,216 | $3,116 – $15,539 |
| Cascade Valley Hospital | — | $1,606 – $9,331 | $2,008 – $11,664 |
| Deaconess Medical Center | — | $1,246 – $6,216 | $3,116 – $15,539 |
| EvergreenHealth Medical Center | — | $240 | $300 |
| Harborview Medical Center | — | $2,209 – $3,603 | $3,155 – $5,147 |
| Highline Medical Center | — | $167 – $15,173 | $548 – $49,690 |
| Island Hospital | $149 – $156 | $462 | $462 |
| Kadlec Regional Medical Center | — | $225 – $13,167 | $322 – $18,810 |
| Mary Bridge Children's Hospital | — | $1,246 – $6,216 | $3,116 – $15,539 |
| MultiCare Auburn Medical Center | — | $1,246 – $6,216 | $3,116 – $15,539 |
| MultiCare Covington Medical Center | — | $1,246 – $6,216 | $3,116 – $15,539 |
| MultiCare Good Samaritan Hospital | — | $1,246 – $6,216 | $3,116 – $15,539 |
| MultiCare Valley Hospital | — | $1,246 – $6,216 | $3,116 – $15,539 |
| Prov Sacred HRT Med Ctr & Childs Hosp. | — | $1,126 – $16,614 | $1,609 – $23,734 |
| Providence Centralia Hospital | — | $1,733 – $14,976 | $3,332 – $28,800 |
| Providence Holy Family Hospital | — | $1,126 – $16,614 | $1,609 – $23,734 |
| Providence Mount Carmel Hospital | — | $1,073 – $15,939 | $1,533 – $22,770 |
| Providence Regional Medical Center Everett | — | $495 – $21,996 | $952 – $42,300 |
| Providence St Joseph Hospital | — | $1,073 – $15,939 | $1,533 – $22,770 |
| Providence St Mary Medical Center | — | $1,169 – $15,183 | $1,671 – $21,690 |
| Providence St Peter Hospital | — | $1,733 – $14,976 | $3,332 – $28,800 |
| Skagit Valley Hospital | — | $1,606 – $9,331 | $2,008 – $11,664 |
| St Anthony Hospital | — | $167 – $15,113 | $548 – $49,690 |
| St Clare Hospital | — | $158 – $14,323 | $548 – $49,690 |
| St Elizabeth Hospital | — | $194 – $17,559 | $548 – $49,690 |
| St Francis Community Hospital | — | $172 – $15,594 | $548 – $49,690 |
| St Joseph Medical Center | — | $182 – $16,457 | $548 – $49,690 |
| St Michael Medical Center | — | $242 – $21,930 | $548 – $49,690 |
| Swedish Edmonds Hospital | — | $1,146 – $17,280 | $2,388 – $36,000 |
| Swedish Issaquah | — | $1,146 – $17,280 | $2,388 – $36,000 |
| Swedish Medical Center | — | $1,146 – $17,280 | $2,388 – $36,000 |
| Swedish Medical Center / Cherry Hill | — | $1,146 – $17,280 | $2,388 – $36,000 |
| Tacoma General Allenmore Hospital | — | $1,246 – $6,216 | $3,116 – $15,539 |
| Trios Health | — | — | $8,975 |
| University of Washington Medical Ctr | — | $391 – $3,202 | $558 – $4,575 |
| Virginia Mason Medical Center | — | $186 – $569 | $364 – $1,115 |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Doctor's fee, Seattle (King County)
- $156 in an office; $156 in a hospital or surgery center
- Doctor's fee, rest of Washington
- $134 in an office; $134 in a hospital or surgery center
- Hospital outpatient payment (national)
- $127 (APC 6002)
- Surgery center payment (national)
- $127