go back

North Dakota 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
$113.28 / $113.28 / $216.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $141.60 / $141.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.90 / $124.52 / $126.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$105.32 / $124.33 / $126.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.13 / $116.28 / $143.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.28 / $141.60 / $192.58
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $128.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.30 / $118.00 / $128.15