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Revitalon

South Carolina 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 South Carolina, 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 $182 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$182$174 to $214

How much rates vary

Facilitymedian $182 · 10th to 90th $158 to $288Professionalmedian $174 · 10th to 90th $126 to $178
$100$200facility $182professional $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
$173.78
Median
$173.78
Typical High
$173.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$173.78
Typical High
$177.83
BCBS
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$134.90
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$144.54
Median
$181.97
Typical High
$323.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$125.89
Medcost
Setting
Facility
Modifier
Global
Typical Low
$165.96
Median
$204.17
Typical High
$295.12
Molina
Setting
Professional
Modifier
Global
Typical Low
$83.18
Median
$87.10
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$102.33
Median
$125.89
Typical High
$208.93
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$125.89
Typical High
$125.89

Where South Carolina 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.

South Carolina· 25th 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.