go back

Arizona rates for HCPCS J1097

Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$151.51 / $283.20 / $629.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.70 / $114.70 / $137.63
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$110.87 / $421.02 / $667.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.88 / $113.28 / $750.62
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.17 / $141.60 / $242.66
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $118.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $118.00