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Maine 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
$328.51 / $328.51 / $1,912.74
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
$93.78 / $117.72 / $307.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $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
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $145.76
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$328.51 / $328.51 / $1,912.74
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $354.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $177.00