go back

Gastrostomy/Jejunostomy Tube, Standard

Wisconsin rates for HCPCS B4087

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

Rates data updated July 2026.

Facilitymedian $34 · 10th–90th $34$850%50%90th$34Professionalmedian $34 · 10th–90th $26$740%20%40%10th90th$34$20.0$50.0$100.0$200.0$500.0

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
$26.30
Median
$173.78
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$23.99
Median
$26.30
Typical High
$33.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$54.95
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$31.62
Median
$31.62
Typical High
$38.02
Cigna
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$102.33
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$45.71
Typical High
$63.10
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$33.11
Typical High
$34.67
Medica
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$34.67
Typical High
$158.49
Medica
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$45.71
Typical High
$107.15
Molina
Setting
Professional
Modifier
Global
Typical Low
$38.02
Median
$64.57
Typical High
$89.13
Network Health
Setting
Facility
Modifier
Global
Typical Low
$74.13
Median
$74.13
Typical High
$74.13
Network Health
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$58.88
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$26.30
Median
$33.11
Typical High
$34.67
Quartz
Setting
Professional
Modifier
Global
Typical Low
$33.88
Median
$63.10
Typical High
$104.71
Quartz
Setting
Facility
Modifier
Global
Typical Low
$67.61
Median
$162.18
Typical High
$162.18
Quartz
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$18.62
Typical High
$18.62
Security Health
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$42.66
Security Health
Setting
Facility
Modifier
Global
Typical Low
$47.86
Median
$47.86
Typical High
$47.86
Security Health
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$42.66
Typical High
$42.66
United
Setting
Facility
Modifier
Global
Typical Low
$33.88
Median
$33.88
Typical High
$33.88
United
Setting
Professional
Modifier
Global
Typical Low
$12.30
Median
$40.74
Typical High
$107.15