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Pennsylvania rates for HCPCS B4087

Gastrostomy/Jejunostomy Tube Standard Any Material Any Type Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.11 / $20.11 / $24.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.20 / $22.24 / $110.94
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.47 / $31.47 / $31.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $18.70
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$45.48 / $120.06 / $277.98
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$20.11 / $20.11 / $24.38
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.20 / $22.24 / $110.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $18.70
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.90 / $33.20 / $33.20
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.90 / $33.20 / $33.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.28 / $32.36 / $49.44