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South Dakota 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 / $816.54 / $1,757.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.53 / $141.60 / $141.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.13 / $116.28 / $143.91
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.60 / $182.24 / $349.19
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $129.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$145.26 / $145.26 / $169.47
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.72 / $141.72 / $141.72
Sanford Health Plan
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 / $129.80
Wellmark
Facility/Professional
Facility
Modifier
Low / Median / High Price
$118.00 / $118.00 / $118.00
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $118.00