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Virginia 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 / $131.43 / $259.98
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$96.91 / $204.48 / $329.49
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.28 / $113.28 / $113.28
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
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$141.60 / $141.60 / $141.60
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$141.60 / $141.60 / $183.31
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.10 / $118.00 / $151.04
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.10 / $118.00 / $151.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.46 / $118.00 / $141.60