J1097 — Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml

What the market charges

Across 1,764 negotiated rates, the middle 80% fall between $67 and $252, with a median of $136.

What Medicare pays

Medicare allowed an average of $95 for this code, across 697,683.7 services billed by 410 providers. At the median, the market charges 1.4 times what Medicare pays for this code.

Where this is billed, and what it costs there

The states billing J1097 most, by Medicare service volume, each compared against the national average of $95. Each links to the providers Mishe lists there.

  • Florida — 41 providers billed it, Medicare allowed $95 — level with the national average
  • California — 26 providers billed it, Medicare allowed $95 — level with the national average
  • Virginia — 11 providers billed it, Medicare allowed $96 — 1% above the national average
  • New York — 16 providers billed it, Medicare allowed $95 — level with the national average
  • New Jersey — 19 providers billed it, Medicare allowed $95 — level with the national average
  • Maryland — 15 providers billed it, Medicare allowed $95 — level with the national average
  • Texas — 22 providers billed it, Medicare allowed $95 — level with the national average
  • Pennsylvania — 24 providers billed it, Medicare allowed $95 — level with the national average

Deploy this for your team

Every figure on this page came from published payer and Medicare data, assembled by Mishe. The same pricing, claim-editing and care-pathway intelligence runs underneath the plans Mishe operates.

Take back healthcare.