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Revitalon

Illinois rates for HCPCS Q4157

Revitalon, per sq cm (add-on, list separately in addition to primary procedure)

Rates data updated July 2026.

How much does Revitalon cost?

$174

Typical negotiated rate. In Illinois, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $174 from a physician practice, and about $204 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 6 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$174$166 to $178
FacilityA hospital or hospital-owned outpatient department$204$166 to $229

How much rates vary

Facilitymedian $204 · 10th to 90th $151 to $302Professionalmedian $174 · 10th to 90th $126 to $178
$100$200$500$1K$2Kfacility $204professional $174

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$165.96
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$173.78
Typical High
$177.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$213.80
Typical High
$380.19
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$302.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$151.36
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$346.74
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
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
$169.82

Where Illinois sits

The same service costs 1.5 times more in Alaska than in Minnesota. 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.

Illinois· 27th of 51

$174

AK $209MN $138

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.