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Gastrostomy/Jejunostomy Tube, Standard

California rates for HCPCS B4087

Gastrostomy/jejunostomy tube, standard, any material, any type, each

Rates data updated July 2026.

Facilitymedian $25 · 10th–90th $19$850%20%10th90th$25Professionalmedian $26 · 10th–90th $16$1580%10%10th90th$26$20.0$50.0$100.0$200.0$500.0

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
$14.79
Median
$17.38
Typical High
$158.49
Aetna
Setting
Professional
Modifier
Global
Typical Low
$14.79
Median
$23.99
Typical High
$158.49
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$24.55
Typical High
$63.10
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$26.92
Typical High
$79.43
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$69.18
Typical High
$97.72
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$93.33
Typical High
$123.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$41.69
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$42.66
Typical High
$83.18
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Providence
Setting
Facility
Modifier
Global
Typical Low
$18.20
Median
$26.92
Typical High
$47.86
Providence
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$38.02
Sutter Health Plus
Setting
Professional
Modifier
Global
Typical Low
$72.44
Median
$72.44
Typical High
$72.44
The Alliance
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$100.00
Typical High
$154.88
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$42.66
Typical High
$42.66
United
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$42.66
Typical High
$114.82