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Revitalon

North Dakota 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?

$170

Typical negotiated rate. In North Dakota, July 2026.

Insurers have agreed to pay about $170 for this service. The price depends on where it is billed: about $170 from a physician practice, and about $166 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 5 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$170$151 to $178
FacilityA hospital or hospital-owned outpatient department$166$166 to $209

How much rates vary

Facilitymedian $166 · 10th to 90th $166 to $234Professionalmedian $170 · 10th to 90th $135 to $204
$100$200$500facility $166professional $170

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
$208.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$173.78
Typical High
$208.93
BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$154.88
Typical High
$194.98
Cigna
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$263.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$147.91
Typical High
$181.97
Medica
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$208.93
Typical High
$309.03
Medica
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$229.09
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$269.15

Where North Dakota 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.

North Dakota· 43rd of 51

$170

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.