Ketorolac injection, 15 mg at Intermountain Health Lutheran Hospital. CPT J1885.
What Intermountain Health Lutheran Hospital publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$24.26list price
$0.30–$50.00range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $4.49 |
| Cigna | Cigna Co Public Option | $5.58 |
| Cigna | Cigna Connect Exchange | $5.58 |
| Cigna | Cigna Surefit | $5.58 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $5.58 |
| Kaiser Perm HMO | Kaiser Out Of State | $5.58 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $5.58 |
| Allegiance | Cigna Sclhs Employees | $6.07 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $6.07 |
| BCBS/Anthem | BCBS Co Exchange Plan | $8.72 |
| BCBS/Anthem | BCBS Co Federal | $8.72 |
| BCBS/Anthem | BCBS Co HMO | $8.72 |
| BCBS/Anthem | BCBS Co PPO | $8.72 |
| Aetna | Aetna HMO/EPO | $8.75 |
| Aetna | Aetna Indemnity | $8.75 |
| Aetna | Aetna Other | $8.75 |
| Aetna | Aetna POS/Qpos | $8.75 |
| Aetna | Aetna PPO | $8.75 |
| Aetna | Aetna Src | $8.75 |
| Aetna | Christian Brothers Emp Ben Trst | $8.75 |
| Geha | Geha-Asa | $8.75 |
| Preferred One | Preferred One | $8.75 |
| Aetna | Aetna Colorado Preferred | $9.02 |
| Choicecare Humana | Choicecare Humana HMO EPO | $10.19 |
| Choicecare Humana | Choicecare Humana PPO | $10.19 |
| Cigna | Cigna HMO | $12.55 |
| Cigna | Cigna Indemnity | $12.55 |
| Cigna | Cigna Local Plus | $12.55 |
| Cigna | Cigna Other | $12.55 |
| Cigna | Cigna POS/Qpos | $12.55 |
Inpatient
—cash price (self-pay)
$24.26list price
$3.07–$55.39range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $7.15 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $10.21 |
| Kaiser Perm HMO | Kaiser Out Of State | $10.21 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $10.21 |
| Kaiser Self Funded | Kaiser Self Funded | $10.21 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $10.53 |
| Private Hlthcare Sys | Phcs Other | $18.19 |
| Private Hlthcare Sys | Phcs PPO | $18.19 |
| BCBS/Anthem | BCBS Co Indemnity | $20.38 |
| Multiplan Inc | Multiplan Inc Other | $20.38 |
| Multiplan Inc | Multiplan Inc PPO | $20.38 |
| Aetna | Aetna Nap | $21.76 |
| Cigna | Cigna HMO | $24.26 |
| Cigna | Cigna Indemnity | $24.26 |
| Cigna | Cigna Local Plus | $24.26 |
| Cigna | Cigna Other | $24.26 |
| Cigna | Cigna POS/Qpos | $24.26 |
| Cigna | Cigna PPO | $24.26 |
| Cigna | Eighth Dist Elect Ben Pln | $24.26 |
| Cigna | Health-Partners | $24.26 |
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All common services at Intermountain Health Lutheran Hospital