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Washington 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 / $120.36 / $120.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.35 / $120.36 / $531.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $141.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.36 / $120.36 / $240.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.36 / $120.36 / $120.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $50.00 / $50.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.22 / $79,999.20 / $79,999.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.53 / $117.53 / $120.36
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.03 / $127.44 / $141.60
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.35 / $120.36 / $279.75
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