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Refill Kit for Implantable Infusion Pump

Washington rates for HCPCS A4220

Refill kit for implantable infusion pump

Rates data updated July 2026.

Facilitymedian $195 · 10th–90th $20$1950%50%10th$195Professionalmedian $20 · 10th–90th $20$200%50%$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$47.86
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
$22.39
Median
$24.55
Typical High
$34.67
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$194.98
Typical High
$194.98
United
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$28.84
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$38.90
Typical High
$69.18