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Refill Kit for Implantable Infusion Pump

Utah rates for HCPCS A4220

Refill kit for implantable infusion pump

Rates data updated July 2026.

Facilitymedian $20 · 10th–90th $20$200%50%$20Professionalmedian $20 · 10th–90th $20$200%50%$20$1.0$5.0$20.0$100.0$500.0$2.0K

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
$19.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$19.95
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$0.91
Typical High
$0.91
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$75.86
Select Health
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$5,011.87
Select Health
Setting
Professional
Modifier
Global
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$33.88