A4220

Refill kit for implantable infusion pump

Medicare pricing data for 3 providers across 1 states

🤖AI Overview

This procedure has a 6.6x markup — hospitals charge $131.94 but Medicare allows only $19.94. Uninsured patients may face bills 6.6 times higher than what insurance negotiates. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Refill kit for implantable infusion pump (HCPCS code A4220) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $19.94, but hospitals typically charge $131.94 — a 6.6x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$3.99

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $19.94, your out-of-pocket cost would be approximately $3.99. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$19.94
Average Hospital Charge
$131.94
Markup Ratio
6.6x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$131.94
Medicare Allowed$19.94
Medicare Payment$15.12

Hospitals charge 6.6x more than what Medicare allows for this procedure. Medicare actually pays $15.12 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Pennsylvania$20$13226,808-0.1%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber

🏥 See Medicare hospital data on OpenMedicare