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Utah rates for HCPCS B4087

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$16.98 / $16.98 / $16.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.98 / $30.20 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.36 / $38.02 / $60.26
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $35.48 / $102.33
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $36.31 / $36.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.20 / $40.74 / $47.86