go back

Idaho 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 / $120.36 / $120.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $120.36 / $121.78
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
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.36 / $129.09 / $174.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.00 / $78.00 / $78.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.59 / $123.59 / $151.66
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $150.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $118.00