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New Jersey 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
$120.35 / $156.46 / $663.95
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.70 / $117.53 / $120.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.58 / $120.36 / $153.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.74 / $433.84 / $13,785.00
Horizon BCBS
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