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West 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 / $120.36 / $141.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.53 / $120.36 / $120.36
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69,999.30 / $69,999.30 / $69,999.30
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 / $179.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $118.00 / $141.60