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Gastrostomy/Jejunostomy Tube, Standard

Pennsylvania rates for HCPCS B4087

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

Rates data updated July 2026.

Facilitymedian $43 · 10th–90th $20$2450%20%10th90th$43Professionalmedian $25 · 10th–90th $15$690%20%40%10th90th$25$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$245.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$24.55
Typical High
$158.49
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$31.62
Typical High
$31.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$53.70
Median
$138.04
Typical High
$275.42
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$19.95
Median
$24.55
Typical High
$245.47
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$22.39
Typical High
$31.62
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$35.48
Median
$169.82
Typical High
$295.12
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$42.66
Typical High
$51.29
United
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$33.88
Typical High
$52.48