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Refill Kit for Implantable Infusion Pump

Pennsylvania rates for HCPCS A4220

Refill kit for implantable infusion pump

Rates data updated July 2026.

Facilitymedian $20 · 10th–90th $20$1150%50%90th$20Professionalmedian $20 · 10th–90th $20$200%50%$20$1.0$10.0$100.0$1.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$25.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$56.23
Median
$58.88
Typical High
$58.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$0.91
Typical High
$0.91
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$16.60
Median
$16.60
Typical High
$16.60
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$186.21
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$12.02
Median
$12.02
Typical High
$12.02
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$74.13
Typical High
$114.82
United
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$60.26
Typical High
$67.61