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Connecticut 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
$120.36 / $180.77 / $395.70
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.30 / $179.38 / $353.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $120.36
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
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.20 / $118.00 / $130.27