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Revitalon

South 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?

$178

Typical negotiated rate. In South Dakota, 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 $174 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 7 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$162 to $182
FacilityA hospital or hospital-owned outpatient department$174$174 to $240

How much rates vary

Facilitymedian $174 · 10th to 90th $174 to $288Professionalmedian $178 · 10th to 90th $148 to $209
$200$500facility $174professional $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
$165.96
Median
$165.96
Typical High
$165.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$177.83
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$194.98
Typical High
$245.47
Cigna
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$181.97
Medica
Setting
Facility
Modifier
Global
Typical Low
$208.93
Median
$281.84
Typical High
$354.81
Medica
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$204.17
Typical High
$794.33
Midlands
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$204.17
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$125.89
Typical High
$269.15
Wellmark
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78

Where South 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.

South Dakota· 4th 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.