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Gastrostomy/Jejunostomy Tube, Standard

South Dakota rates for HCPCS B4087

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

Rates data updated July 2026.

Facilitymedian $50 · 10th–90th $25$1100%10%20%10th90th$50Professionalmedian $36 · 10th–90th $32$460%20%10th90th$36$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$25.12
Median
$25.12
Typical High
$25.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$33.11
Median
$39.81
Typical High
$39.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$36.31
Typical High
$45.71
Medica
Setting
Facility
Modifier
Global
Typical Low
$42.66
Median
$57.54
Typical High
$109.65
Medica
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$35.48
Typical High
$61.66
Midlands
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$44.67
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$35.48
Typical High
$41.69
United
Setting
Professional
Modifier
Global
Typical Low
$11.48
Median
$32.36
Typical High
$58.88
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$42.66