Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml
Medicare pricing data for 534 providers across 45 states
Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml (HCPCS code J1097) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $95.35, but hospitals typically charge $301.66 — a 3.2x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $95.35, your out-of-pocket cost would be approximately $19.07. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 3.2x more than what Medicare allows for this procedure. Medicare actually pays $76.05 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| New Hampshire | $96 | $347 | 2 | 8,483 | +0.4% |
| Massachusetts | $96 | $419 | 8 | 6,556 | +0.4% |
| Wisconsin | $96 | $243 | 8 | 9,313 | +0.3% |
| Nebraska | $96 | $384 | 8 | 11,828 | +0.3% |
| Missouri | $96 | $626 | 11 | 12,526 | +0.2% |
| Hawaii | $96 | $573 | 4 | 6,032 | +0.2% |
| Tennessee | $96 | $153 | 12 | 31,168 | +0.2% |
| New York | $96 | $221 | 21 | 44,679 | +0.2% |
| South Carolina | $96 | $302 | 11 | 30,133 | +0.2% |
| Delaware | $96 | $301 | 2 | 5,443 | +0.2% |
| Arkansas | $96 | $255 | 10 | 16,753 | +0.2% |
| Georgia | $95 | $884 | 22 | 31,668 | +0.1% |
| Colorado | $95 | $215 | 6 | 12,943 | +0.1% |
| Nevada | $95 | $184 | 4 | 8,714 | +0.1% |
| Wyoming | $95 | $212 | 3 | 5,109 | +0.1% |
| Indiana | $95 | $188 | 7 | 11,842 | +0.1% |
| Texas | $95 | $327 | 30 | 40,665 | +0.1% |
| Florida | $95 | $331 | 49 | 81,078 | +0.1% |
| Virginia | $95 | $184 | 15 | 45,665 | +0.1% |
| Alabama | $95 | $185 | 8 | 16,616 | +0.1% |
| Michigan | $95 | $166 | 9 | 15,862 | +0.1% |
| Ohio | $95 | $281 | 23 | 25,870 | +0.1% |
| Arizona | $95 | $161 | 13 | 9,283 | +0.1% |
| California | $95 | $311 | 38 | 57,024 | +0.1% |
| Oklahoma | $95 | $451 | 7 | 8,778 | +0.1% |
| New Jersey | $95 | $340 | 31 | 32,580 | +0.0% |
| Louisiana | $95 | $200 | 13 | 8,741 | +0.0% |
| Illinois | $95 | $247 | 16 | 27,984 | +0.0% |
| Utah | $95 | $574 | 2 | 545 | -0.0% |
| Kentucky | $95 | $282 | 5 | 3,438 | -0.0% |
| Minnesota | $95 | $185 | 9 | 6,866 | -0.1% |
| West Virginia | $95 | $237 | 2 | 4,841 | -0.1% |
| Mississippi | $95 | $175 | 12 | 38,565 | -0.1% |
| Pennsylvania | $95 | $390 | 32 | 39,531 | -0.2% |
| North Dakota | $95 | $246 | 6 | 17,974 | -0.3% |
| North Carolina | $95 | $561 | 17 | 28,162 | -0.3% |
| South Dakota | $95 | $159 | 8 | 22,398 | -0.4% |
| Connecticut | $95 | $161 | 5 | 2,256 | -0.5% |
| Iowa | $95 | $259 | 5 | 9,860 | -0.5% |
| Oregon | $95 | $131 | 4 | 2,157 | -0.5% |
| Maryland | $95 | $209 | 21 | 50,885 | -0.5% |
| Washington | $94 | $243 | 4 | 1,544 | -0.9% |
| Kansas | $94 | $130 | 2 | 681 | -1.4% |
| Rhode Island | $94 | $322 | 1 | 436 | -1.6% |
| Alaska | $93 | $151 | 1 | 1,611 | -2.0% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber