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Nebraska 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 / $272.17 / $1,757.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $113.28 / $190.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.13 / $120.36 / $143.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$97.42 / $141.60 / $531.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $141.60
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.26 / $173.86 / $227.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.72 / $141.72 / $141.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.10 / $118.00 / $129.80