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Phenylephrine and Ketorolac Ophthalmic Irrigation Solution

Wisconsin rates for HCPCS J1097

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

Rates data updated July 2026.

Facilitymedian $195 · 10th–90th $112$3550%10%20%10th90th$195Professionalmedian $117 · 10th–90th $112$1410%50%10th90th$117$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$354.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$112.20
Typical High
$141.25
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$177.83
Median
$208.93
Typical High
$213.80
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$117.49
Cigna
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$275.42
Typical High
$467.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$128.82
Typical High
$147.91
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$141.25
Medica
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$181.97
Typical High
$269.15
Medica
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$154.88
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$85.11
Network Health
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$151.36
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$141.25
Quartz
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$363.08
Typical High
$524.81
Quartz
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$120.23
Typical High
$120.23
United
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$229.09
United
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$117.49
Typical High
$162.18