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Revitalon

Missouri 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?

$166

Typical negotiated rate. In Missouri, July 2026.

Insurers have agreed to pay about $166 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $195 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$166$123 to $174
FacilityA hospital or hospital-owned outpatient department$195$166 to $240

How much rates vary

Facilitymedian $195 · 10th to 90th $102 to $324Professionalmedian $166 · 10th to 90th $98 to $182
$100$200$500facility $195professional $166

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
$165.96
Median
$165.96
Typical High
$218.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$165.96
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$109.65
Typical High
$138.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$144.54
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$239.88
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$151.36
Medica
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$208.93
Typical High
$457.09
Medica
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$204.17
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$269.15
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$125.89
Typical High
$151.36

Where Missouri 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.

Missouri· 46th of 51

$166

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.