Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
Revitalon 1 square cm
Cedar Rapids, IA
See all hospitals reporting HCPCS Q4157 →Price type
St Luke's Methodist Hospital’s median price of $173 is 15% below the median hospital's median price ($203), higher than 32% of the 838 hospitals reporting HCPCS Q4157. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 3 payers, 10 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | |||||||
|---|---|---|---|---|---|---|---|
| 1 | Aetna hmo fee schedule · both | $50 | $50 | — | — | — | $50 – $50 |
| 2 | Aetna ppo fee schedule · both | $50 | $50 | — | — | — | $50 – $50 |
| 3 | Wellmark commercial fee schedule · both | $173 | $173 | — | — | — | $173 – $173 |
| 4 | Wellmark commercial fee schedule · outpatient | $173 | $173 | — | — | — | $173 – $173 |
| 5 | Wellmark hmo fee schedule · both | $173 | $173 | — | — | — | $173 – $173 |
| 6 | Wellmark hmo fee schedule · outpatient | $173 | $173 | — | — | — | $173 – $173 |
| 7 | Wellmark ppo fee schedule · both | $173 | $173 | — | — | — | $173 – $173 |
| 8 | Wellmark ppo fee schedule · outpatient | $173 | $173 | — | — | — | $173 – $173 |
| 9 | UnitedHealthcare hmo fee schedule · both | $203 | $203 | — | — | — | $203 – $203 |
| 10 | UnitedHealthcare ppo fee schedule · both | $203 | $203 | — | — | — | $203 – $203 |
Last updated: Jan 28, 2026
See Revitalon skin substitute, per square centimeter pricing across every hospital in the network reporting it, or ask Claude or any MCP client directly — see how to connect.