Ketorolac injection, 15 mg at Good Samaritan Hospital (GSH). CPT J1885.
What Good Samaritan Hospital (GSH) publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
$22.20cash price (self-pay)
$47.00list price
$0.24–$67.50range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Medicaid | $0.24 |
| Aetna | Medicare Advantage | $0.33 |
| Allwell | MCR ADV/PPO/HMO | $0.33 |
| Anthem MCR | MCR ADV/PPO/HMO | $0.33 |
| Anthem MCR | Medicare Advantage | $0.33 |
| Anthem | MCR ADV/PPO/HMO | $0.33 |
| Cigna | Medicare Advantage | $0.33 |
| Humana | Medicare Advantage | $0.33 |
| United Healthcare | Medicare Advantage | $0.33 |
| Indiana University | MCR ADV/PPO/HMO | $0.33 |
| MHS Ambetter | Commercial | $0.33 |
| Meridian | Medicare Advantage | $0.33 |
| Molina | Medicaid | $0.33 |
| Molina | Medicare Advantage | $0.33 |
| Optum | MCR ADV/PPO/HMO | $0.33 |
| Anthem HIP | HIP | $0.33 |
| BCBS | Medicare Advantage | $0.33 |
| Alliance Coal | Commercial | $0.42 |
| CareSource | Commercial | $0.45 |
| Hope Trust | Commercial | $0.66 |
| Amish | Commercial | $23.50 |
| Anthem | Exchange | $26.82 |
| United Healthcare | Commercial | $30.83 |
| Aetna | Commercial | $31.54 |
| Anthem | Trad/PPO/HMO | $33.52 |
| OneCare | Commercial | $35.81 |
| Indiana University | Commercial | $35.81 |
| Direct Health | Direct Health | $36.05 |
| SIHO | Commercial | $36.05 |
| Cigna | Commercial | $37.13 |
Inpatient
$22.20cash price (self-pay)
$47.00list price
$21.53–$67.50range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem | Exchange | $27.34 |
| United Healthcare | Commercial | $31.11 |
| Anthem | Trad/PPO/HMO | $34.18 |
| Direct Health | Direct Health | $36.05 |
| SIHO | Commercial | $36.05 |
| Cigna | Commercial | $37.13 |
| Sagamore | Commercial | $37.13 |
| Corvel | Workers Comp | $38.54 |
| Aetna | Commercial | $39.39 |
| Anthem | HealthSync | $40.42 |
| HealthLink | HMO | $41.36 |
| Encore Prime | Commercial | $42.30 |
| Humana | Commercial | $42.30 |
| HealthLink | PPO | $43.71 |
| Molina | Medicaid | $47.00 |
| Underwriters Safety | Commercial | $47.00 |
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