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Ohio 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 / $278.95 / $433.30
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $113.28 / $314.92
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.35 / $112.35 / $112.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$104.66 / $171.82 / $312.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.25 / $127.44 / $220.87
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 / $189.37
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.72 / $232.85 / $563.21
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $189.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.00 / $50.00 / $50.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $127.63