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Missouri 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
$112.20 / $141.25 / $457.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $117.49 / $194.98
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $104.71 / $338.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $107.15 / $141.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $120.23 / $120.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $120.23 / $120.23
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $138.04 / $537.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $117.49 / $138.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.72 / $162.18 / $190.55
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $117.49 / $138.04