Ketorolac injection, 15 mg at St. Luke's Jerome Standard Charges. CPT J1885.
What St. Luke's Jerome Standard Charges publishes for this service, straight from its standard-charges file, last updated March 25, 2026.
Outpatient / ER
$2.18cash price (self-pay)
$15.18list price
$0.33–$29.10range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Commercial [1028] | Hb Mv Va Ccn | $0.33 |
| Medicare Advantage Generic [1019] | Hb Mv Medicare Advantage | $0.33 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Mmcp | $0.33 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Mmcp | $0.33 |
| Blue Cross/Medicare Advantage [1009] | Hb Mv Bci True & Secure Med Adv | $0.34 |
| Medicare Advantage Generic [1019] | Hb Mv Molina Med Adv | $0.34 |
| Medicare Advantage Molina [1053] | Hb Mv Molina Med Adv | $0.34 |
| Cigna [1062] | Hb Mv Cigna | $0.37 |
| Commercial [1028] | Hb Mv Cigna | $0.37 |
| Medicare Advantage Aetna [1017] | Hb Mv Aetna Med Adv | $0.37 |
| Slplan Tap Mc St Lukes Health Plan [1641000001] | Hb Mv Slhp St Lukes | $0.53 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Carepoint Qhp | $0.53 |
| Blue Cross Idaho [1007] | Hb Mv Slhp Blue Cross Large Group | $0.53 |
| Commercial [1028] | Hb Mv Slhp Mountain Health Coop | $0.53 |
| Commercial [1028] | Hb Mv Slhp Select Health | $0.53 |
| Commercial [1028] | Hb Mv Slhp Select Health Qhp | $0.53 |
| Commercial [1028] | Hb Mv H2b | $11.39 |
| H2b [1068] | Hb Mv H2b | $11.39 |
| Pacificsource [1020] | Hb Mv Pacificsource PPO Voyager | $11.39 |
| Aetna [1021] | Hb Mv Bp Aetna | $12.14 |
| Commercial [1028] | Hb Mv Bp Aetna | $12.14 |
| Commercial [1028] | Hb Mv Multiplan Primary Network | $12.14 |
| Webtpa [1071] | Hb Mv Bp Aetna | $12.14 |
| Blue Cross Federal [1008] | Hb Mv Bci PPO Fep | $12.45 |
| Blue Cross Idaho [1007] | Hb Mv Bci PPO Fep | $12.45 |
| Commercial [1028] | Hb Mv Amps | $12.90 |
| Commercial [1028] | Hb Mv Christian Health Aid | $12.90 |
| Commercial [1028] | Hb Mv First Choice Health | $12.90 |
| First Health [1064] | Hb Mv First Choice Health | $12.90 |
| Webtpa [1071] | Hb Mv First Choice Health | $12.90 |
Inpatient
$2.18cash price (self-pay)
$15.18list price
$1.42–$24.50range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Medicare Advantage Pacificsource [1039] | Hb Mv Slhp Pacificsource Med | $9.87 |
| Cigna [1062] | Hb Mv Cigna | $12.14 |
| Commercial [1028] | Hb Mv Cigna | $12.14 |
| Commercial [1028] | Hb Mv Va Ccn | $12.14 |
| Providence [1022] | Hb Mv Cigna | $12.14 |
| Veterans Affairs [1056] | Hb Mv Va Ccn | $12.14 |
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