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Ketorolac injection, 15 mg at Samaritan Hospital. CPT J1885.

What Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated March 31, 2026.

Outpatient / ER

$3.41cash price (self-pay)
$10.40list price
$0.29–$10.40range insurers pay
Insurance planNegotiated rate
Blue Cross - Az | Blue Shield Of Ne New York PPO$4.59
Blue Cross - NY (Excellus) | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Al | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Nj (Horizon) | Blue Shield Of Ne New York HMO$4.59
Blue Cross - Nj (Horizon) | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Ne | Blue Shield Of Ne New York PPO$4.59
Blue Cross - IL | Blue Shield Of Ne New York HMO$4.59
Blue Cross - IL | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Ak (Premera) | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Nm | Blue Shield Of Ne New York PPO$4.59
Blue Shield - NY Highmark Western | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Ar | Blue Shield Of Ne New York PPO$4.59
Harvard Pilgrim Healthcare | United Healthcare$4.59
Blue Shield - NY Highmark Northeastern | Blue Shield Of Ne New York Pp$4.59
Blue Shield - NY Highmark Northeastern | Blue Shield Of Ne New York As$4.59
Blue Cross - FL | Blue Shield Of Ne New York HMO$4.59
Blue Cross - FL | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Ok | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Pa (Independence) | Blue Shield Of Ne New York HMO$4.59
Blue Cross - Pa (Independence) | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Or (Regence) | Blue Shield Of Ne New York PPO$4.59
Blue Shield - CA | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Nc | Blue Shield Of Ne New York PPO$4.59
Blue Cross - De (Highmark) | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Dc (Carefirst) | Blue Shield Of Ne New York PPO$4.59
Blue Shield - NY Highmark Northeastern | Blue Shield Of Ne New York Hm$4.59
Blue Cross - MA | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Mi | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Ms | Blue Shield Of Ne New York PPO$4.59
Blue Cross - Mn | Blue Shield Of Ne New York PPO$4.59

Inpatient

$27.55cash price (self-pay)
$27.55list price
$1.15–$27.55range insurers pay
Insurance planNegotiated rate
Union Health Service | Pb Xr 100% Default$27.55
Everence | Pb Xr 100% Default$27.55
Health Choices | Pb Xr 100% Default$27.55
Commonwealth Care Alliance | Pb Xr 100% Default$27.55
Pace Of Southwest Michigan | Pb Xr 100% Default$27.55
Dentaquest | Pb Xr 100% Default$27.55
Rx Allwin | Pb Xr 100% Default$27.55
Harvard Pilgrim Healthcare | Pb Xr 100% Default$27.55
Molina Medicare Advantage | Pb Xr 100% Default$27.55
The Health Plan | Pb Xr 100% Default$27.55
Diversified Administrators | Pb Xr 100% Default$27.55
Acs Benefit Services | Pb Xr 100% Default$27.55
Molina Centennial Care | Pb Xr 100% Default$27.55
Community Health Choice | Pb Xr 100% Default$27.55
Advocate Health | Pb Xr 100% Default$27.55
Malta House | Pb Xr 100% Default$27.55
Sandhills Center Lme | Pb Xr 100% Default$27.55
Advanced Correctional Healthcare | Pb Xr 100% Default$27.55
Local - Ct | Pb Xr 100% Default$27.55
Vaya Health Lme | Pb Xr 100% Default$27.55
Rx Rx Advance Commercial | Pb Xr 100% Default$27.55
Admiral Life | Pb Xr 100% Default$27.55
Insurance Programmers Inc | Pb Xr 100% Default$27.55
Highmark Wholecare Medicare Advantage | Pb Xr 100% Default$27.55
Olympus Managed Health Care | Pb Xr 100% Default$27.55
Careplus Health Plans | Pb Xr 100% Default$27.55
Avmed Medicare | Pb Xr 100% Default$27.55
Wc Srs | Pb Xr 100% Default$27.55
Wc Meijers | Pb Xr 100% Default$27.55
Positive Healthcare Partners Medicare | Pb Xr 100% Default$27.55
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