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Wisconsin rates for HCPCS B4087

Gastrostomy/Jejunostomy Tube Standard Any Material Any Type Each

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.26 / $26.26 / $175.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.22 / $26.26 / $110.94
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.74 / $32.74 / $54.02
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.45 / $30.45 / $36.01
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.47 / $70.06 / $70.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.80 / $97.93 / $150.22
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $45.47 / $61.61
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.22 / $32.74 / $34.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$26.26 / $34.38 / $158.61
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.75 / $51.89 / $125.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.59 / $65.00 / $90.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24.22 / $32.74 / $34.38
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.74 / $58.80 / $98.36
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.58 / $66.45 / $158.61
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.70 / $18.70 / $18.70
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.34 / $41.34 / $41.34
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.77 / $47.77 / $47.77
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.34 / $41.34 / $41.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.74 / $32.74 / $32.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12.21 / $43.95 / $115.42