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Refill Kit for Implantable Infusion Pump

Wisconsin rates for HCPCS A4220

Refill kit for implantable infusion pump

Rates data updated July 2026.

Facilitymedian $30 · 10th–90th $20$1230%20%40%10th90th$30Professionalmedian $20 · 10th–90th $4$440%50%10th90th$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. 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
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$3.98
Median
$3.98
Typical High
$6.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$109.65
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$43.65
Typical High
$50.12
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$36.31
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$120.23
Typical High
$162.18
Medica
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$100.00
Medica
Setting
Professional
Modifier
Global
Typical Low
$51.29
Median
$51.29
Typical High
$60.26
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$50.12
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$19.95
Typical High
$36.31
Quartz
Setting
Professional
Modifier
Global
Typical Low
$5,888.44
Median
$5,888.44
Typical High
$5,888.44
Quartz
Setting
Facility
Modifier
Global
Typical Low
$64.57
Median
$64.57
Typical High
$100.00
Quartz
Setting
Professional
Modifier
Global
Typical Low
$0.91
Median
$0.91
Typical High
$0.91
Security Health
Setting
Professional
Modifier
Global
Typical Low
$30.90
Median
$32.36
Typical High
$36.31
United
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$48.98