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Revitalon

New York 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?

$178

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $178 for this service. The price depends on where it is billed: about $178 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 8 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$178$151 to $200
FacilityA hospital or hospital-owned outpatient department$166$155 to $178

How much rates vary

Facilitymedian $166 · 10th to 90th $138 to $200Professionalmedian $178 · 10th to 90th $126 to $200
$200$500$1Kfacility $166professional $178

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
$144.54
Median
$165.96
Typical High
$177.83
Aetna
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$173.78
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$199.53
Typical High
$302.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$165.96
Typical High
$190.55
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$138.04
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$199.53
Typical High
$501.19
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$177.83
Typical High
$239.88
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$50,118.72
Typical High
$75,857.76
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$138.04
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$151.36
Typical High
$190.55
Univera
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
Univera
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18

Where New York 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.

New York· 5th of 51

$178

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.