Phenylephrine and Ketorolac Ophthalmic Irrigation Solution

Rhode Island rates for HCPCS J1097 · Omidria

Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml

Rates data updated October 2026.

How much does Omidria (phenylephrine and ketorolac) cost?

$479per dose

One 4 mL dose, at the doctor's office rate. In Rhode Island, October 2026.

Negotiated ratewhat insurers pay per mL of the drug: $120 / mL
Average doseacross Medicare claims, discarded units included: × 4 mL
One dosedrug only; giving it and the visit are billed separately: $479

Work out the cost of a dose

This drug is priced per mL. Enter the amount given to see what insurers have agreed to pay for it. Prefilled with the average administration in Medicare claims, discarded units included.

Amount givenmL

In a doctor's office or clinic: $481
At a hospital outpatient department: $504

The same drug, in the same amount, costs 5% more at a hospital than at a doctor's office.

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Where the price changes

Given at	Per mL	Per 4 mL dose
Doctor's office or clinic	$120	$479
Hospital outpatient department	$126	$501

How much rates vary

Facilitymedian $126 · 10th to 90th $120 to $158Professionalmedian $120 · 10th to 90th $117 to $129

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier	Facility/Professional	Modifier	Typical Low	Median	Typical High
Aetna Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23	Professional	None	$120.23	$120.23	$120.23
BCBS Rhode Island Setting Facility Modifier None Typical Low $120.23 Median $125.89 Typical High $131.83	Facility	None	$120.23	$125.89	$131.83
BCBS Rhode Island Setting Professional Modifier None Typical Low $128.82 Median $128.82 Typical High $128.82	Professional	None	$128.82	$128.82	$128.82
Cigna Setting Facility Modifier None Typical Low $120.23 Median $154.88 Typical High $229.09	Facility	None	$120.23	$154.88	$229.09
Cigna Setting Professional Modifier None Typical Low $120.23 Median $120.23 Typical High $120.23	Professional	None	$120.23	$120.23	$120.23
United Setting Facility Modifier None Typical Low $95.50 Median $95.50 Typical High $95.50	Facility	None	$95.50	$95.50	$95.50
United Setting Professional Modifier None Typical Low $117.49 Median $117.49 Typical High $117.49	Professional	None	$117.49	$117.49	$117.49

Where Rhode Island sits

The same service costs 2.3 times more in Texas than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Rhode Island· 14th of 51

$120

TX $263HI $115

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.