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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 October 2026.

How much does Gastrostomy/Jejunostomy Tube, Standard cost?

$24.55

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $24.55 for this service. The price depends on where it is billed: about $22.39 from a physician practice, and about $102 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 7 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$22.39$19.95 to $31.62
FacilityA hospital or hospital-owned outpatient department$102$33.11 to $191

How much rates vary

Facilitymedian $102 · 10th to 90th $25 to $4,266Professionalmedian $22 · 10th to 90th $19 to $36
$10$100$1K$10K$100Kfacility $102professional $22

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$19.95
Median
$19.95
Typical High
$24.55
Aetna
Setting
Professional
Modifier
None
Typical Low
$19.95
Median
$22.39
Typical High
$29.51
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$31.62
Median
$31.62
Typical High
$31.62
Cigna
Setting
Professional
Modifier
None
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Highmark BCBS
Setting
Facility
Modifier
None
Typical Low
$53.70
Median
$138.04
Typical High
$190.55
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$19.95
Median
$19.95
Typical High
$24.55
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$19.95
Median
$22.39
Typical High
$24.55
UPMC Health Plan
Setting
Facility
Modifier
None
Typical Low
$33.11
Median
$151.36
Typical High
$257.04
UPMC Health Plan
Setting
Professional
Modifier
None
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
United
Setting
Facility
Modifier
None
Typical Low
$42.66
Median
$42.66
Typical High
$51.29
United
Setting
Professional
Modifier
None
Typical Low
$12.02
Median
$33.88
Typical High
$51.29

Where Pennsylvania sits

The same service costs 2.5 times more in Iowa than in New Jersey. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Pennsylvania· 46th of 51

$24.55

IA $45.71NJ $18.62

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.