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Gastrostomy/Jejunostomy Tube, Standard

Virginia rates for HCPCS B4087

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

Rates data updated July 2026.

Facilitymedian $32 · 10th–90th $27$380%50%10th90th$32Professionalmedian $26 · 10th–90th $19$450%10%20%10th90th$26$20.0$100.0$500.0$2.0K$10.0K

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
$19.50
Median
$19.50
Typical High
$33.11
Aetna
Setting
Professional
Modifier
Global
Typical Low
$19.50
Median
$19.95
Typical High
$33.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$34.67
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$26.30
Median
$26.30
Typical High
$37.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$21.88
Median
$21.88
Typical High
$46.77
Cigna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$28.18
Median
$38.90
Typical High
$63.10
Medcost
Setting
Professional
Modifier
Global
Typical Low
$53.70
Median
$53.70
Typical High
$53.70
Medcost
Setting
Facility
Modifier
Global
Typical Low
$19.50
Median
$31.62
Typical High
$46.77
Medcost
Setting
Professional
Modifier
Global
Typical Low
$17.38
Median
$17.38
Typical High
$23.44
Sentara
Setting
Facility
Modifier
Global
Typical Low
$23.44
Median
$38.02
Typical High
$10,000.00
Sentara
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$38.02
Typical High
$10,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$33.11
Median
$33.11
Typical High
$33.11
United
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$33.11
Typical High
$54.95