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Refill Kit for Implantable Infusion Pump

South Dakota rates for HCPCS A4220

Refill kit for implantable infusion pump

Rates data updated July 2026.

Facilitymedian $34 · 10th–90th $20$650%20%40%10th90th$34Professionalmedian $20 · 10th–90th $20$490%50%90th$20$1.0$2.0$5.0$10.0$20.0$50.0$100.0

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$52.48
Median
$52.48
Typical High
$64.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$48.98
Medica
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$33.88
Typical High
$64.57
Midlands
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$60.26
Typical High
$60.26
Midlands
Setting
Professional
Modifier
Global
Typical Low
$57.54
Median
$57.54
Typical High
$57.54
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$37.15
Typical High
$42.66
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$0.60
Median
$0.60
Typical High
$0.60