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

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

Outpatient / ER

$0.26cash price (self-pay)

$15.00list price

$0.09–$91.67range insurers pay

Insurance plan	Negotiated rate
Providence \| Medicare Adv. - Physician	$0.33
Providence \| EPO - Pebb/Oebb	$0.35
Providence \| EPO - Non Pebb/Oebb	$0.35
Devoted Health \| Medicare Advantage - Midlevel - Fac	$0.35
DEVOTED HEALTH \| Medicare Advantage-NONFAC	$0.35
DEVOTED HEALTH \| Medicare Advantage-FAC	$0.35
Devoted Health \| Medicare Advantage - Midlevel - Nonfac	$0.35
First Choice \| Nonfacility	$0.35
First Choice \| Facility	$0.35
Healthnet \| Medicare Advantage - Midlevel - Nonfac	$0.35
Healthnet \| Medicare Advantage - Fac	$0.35
Healthnet \| Medicare Advantage - Midlevel - Fac	$0.35
Healthnet \| Facility	$0.36
Aetna \| Fac - Midlevel Lcsw/Lpc/Rdn	$0.64
Aetna \| Nonfac - Psychiatric Np	$0.64
Aetna \| Fac - Psychiatric Np	$0.64
Aetna \| Nonfac - Midlevel Lcsw/Lpc/Rdn	$0.64
Aetna \| Fac - Optometrists - Pyschologists- Pt-St-Ot	$0.64
Aetna \| Nonfac - Md-Do	$0.64
Aetna \| Fac - Md-Do	$0.64
Aetna \| Fac - Midlevel Np-Pa-Cnm	$0.64
Aetna \| Nonfac - Optometrists - Pyschologists- Pt-St-Ot	$0.64
Aetna \| Nonfac - Midlevel Np-Pa-Cnm	$0.64
Providence \| Individual-Standard	$0.66
Cigna \| Nonfacility	$0.83
Cigna \| Facility	$0.83
Providence \| MA-Behavioral Health	$4.35
Providence \| Medicare Adv.	$4.35
Samaritan \| Medicare Adv.	$4.39
Healthnet \| Medicare Adv.	$4.79

$0.26cash price (self-pay)

$15.00list price

$0.09–$91.67range insurers pay

Insurance plan	Negotiated rate
Providence \| EPO - Pebb/Oebb	$14.55
Providence \| EPO - Non Pebb/Oebb	$14.55
Providence \| Individual-Standard	$14.55

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