Ketorolac injection, 15 mg at CHI Health Good Samaritan. CPT J1885.

What CHI Health Good Samaritan publishes for this service, straight from its standard-charges file, last updated February 28, 2026.

Outpatient / ER

$0.57cash price (self-pay)

$2.15list price

$0.20–$4.39range insurers pay

Insurance plan	Negotiated rate
BCBS - NE \| Medicare\|All Plans	$0.33
Humana \| Medicare\|All Plans	$0.33
Medica \| Medicare\|All Plans	$0.33
PACE \| Medicare\|All Plans	$0.33
Centene \| Medicare\|All Plans	$0.34
Amerigroup \| Medicare\|All Plans	$0.35
Great Plains \| Medicare\|All Plans	$0.35
United \| Medicaid\|Community Plan	$0.45
Centene \| Medicaid\|NE Total Care	$0.46
BCBS - NE \| Commercial\|BluePrint	$0.70
United \| Medicare\|All Plans	$0.71
AMPS \| Commercial\|All Plans	$0.73
BCBS - NE \| Commercial\|All Other Plans	$0.94
Medica \| Commercial\|ACO	$1.03
Creighton University Employees \| Commercial\|All Plans	$1.06
Medica \| Commercial\|CHI Health	$1.21
ELAP \| Commercial\|All Plans	$1.25
Medica \| Commercial\|All Other Plans	$1.27
Greater Omaha Packing \| Commercial\|Narrow Network	$1.44
Millard Public Schools \| Commercial\|Narrow Network	$1.44
One World \| Commercial\|Narrow Network	$1.44
Amerigroup \| Medicaid\|All Plans	$1.53
Centene \| Medicaid\|IA Total Care	$1.53
IAMolina \| Medicaid\|All Plans	$1.56
Greater Omaha Packing \| Commercial\|Broad Network	$1.59
Millard Public Schools \| Commercial\|Broad Network	$1.59
One World \| Commercial\|Broad Network	$1.59
Timpte \| Commercial\|Broad Network	$1.59
United \| Commercial\|All Plans	$1.64
Medica \| Commercial\|Open Access	$1.68

$0.57cash price (self-pay)

$2.15list price

$0.46–$4.39range insurers pay

Insurance plan	Negotiated rate
Creighton University Employees \| Commercial\|All Plans	$1.06
United \| Commercial\|All Plans	$1.64
Medica \| Commercial\|Open Access	$1.68
Midlands Choice \| Commercial\|Premier	$1.68
Midlands Choice \| Commercial\|Standard	$1.98
MultiPlan PHCS \| Commercial\|All Plans	$2.00

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