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Oregon 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
$120.36 / $120.36 / $283.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.53 / $117.53 / $120.36
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$240.72 / $240.72 / $240.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.53 / $168.07 / $252.69
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.98 / $125.98 / $242.28
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.50 / $79,999.20 / $79,999.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$123.07 / $155.76 / $252.69
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $147.50 / $147.50
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.35 / $133.05 / $547.14
Regence BlueShield
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 / $118.00