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Tennessee 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
$117.53 / $148.09 / $418.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $117.53 / $117.53
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 / $120.36
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$139.50 / $521.65 / $531.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $120.36