Ketorolac injection, 15 mg at Samuel Mahelona Memorial Hospital. CPT J1885.
What Samuel Mahelona Memorial Hospital publishes for this service, straight from its standard-charges file, last updated June 15, 2026.
Outpatient / ER
$3.04cash price (self-pay)
$12.68list price
$0.34–$44.81range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Hawaii Medical Service Association | ABD | $0.35 |
| Hawaii Medical Service Association | Non-ABD | $0.35 |
| Hawaii Medical Service Association | Commercial | $0.42 |
| AlohaCare | Medicare | $6.09 |
| Hawaii Medical Service Association | Medicare | $6.09 |
| Kaiser Permanente | Medicare | $6.09 |
| Ohana Health Plan | Medicare | $6.09 |
| UnitedHealthcare | Medicare | $6.09 |
| Kaiser Permanente | Medicaid | $6.21 |
| AlohaCare | Medicaid | $6.34 |
| Humana | Medicare | $6.34 |
| Ohana Health Plan | Medicaid | $6.34 |
| Devoted Health | Medicare | $6.70 |
| UnitedHealthcare | Medicaid | $7.61 |
| University Health Alliance | Commercial | $9.24 |
| Health Management Network | Commercial | $10.36 |
| Kaiser Permanente | Commercial | $10.96 |
| MDX Hawaii | PPO | $12.30 |
| Hawaii Western Management Group | Commercial | $12.36 |
Inpatient
$3.04cash price (self-pay)
$12.68list price
$3.97–$44.81range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Management Network | Commercial | $10.78 |
| Kaiser Permanente | Commercial | $11.41 |
| MDX Hawaii | PPO | $12.30 |
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