I have a 2070 Super and at 4k I'm not really able to go even Medium ray tracing at 60fps. I can do Medium ray tracing and even Ultra with a lot of tweaking and get 30-40fps but at that point I don't think it's worth it in 4k.
3rd playthrough already? I haven't even finished my first playthrough. Also, in any of your builds did you try out the Venomous Fangs perk? I'm curious how that works, and how good a "poison" stealth build is.