go back

Louisiana 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
$141.60 / $141.60 / $991.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.60 / $141.60 / $141.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$94.16 / $110.48 / $127.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.44 / $127.44 / $129.99
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$379.61 / $379.61 / $379.61
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $141.60