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Gastrostomy/Jejunostomy Tube, Standard

Utah rates for HCPCS B4087

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

Rates data updated July 2026.

Facilitymedian $17 · 10th–90th $17$460%50%90th$17Professionalmedian $32 · 10th–90th $17$330%20%40%10th90th$32$20.0$50.0

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
$17.38
Median
$17.38
Typical High
$17.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$30.20
Typical High
$33.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$45.71
Typical High
$60.26
Select Health
Setting
Facility
Modifier
Global
Typical Low
$36.31
Median
$36.31
Typical High
$36.31
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$36.31
Typical High
$36.31
United
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$44.67
Typical High
$47.86