Ketorolac injection, 15 mg at WellSpan Good Samaritan Hospital. CPT J1885.
What WellSpan Good Samaritan Hospital publishes for this service, straight from its standard-charges file, last updated January 1, 2026.
Outpatient / ER
$30.00cash price (self-pay)
$37.50list price
$0.23–$522range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Blue_Cross | Capital_Cares_4_kids | $0.23 |
| Blue_Cross | Capital_Blue_Cross_Healthy_Benefits_PPO | $0.26 |
| Amerihealth_Caritas_Medicaid | All_Plans | $0.30 |
| Blue_Cross_BlueJourney_Medicare | All_Plans | $0.30 |
| Highmark_Wholecare_Gateway_Medicaid | All_Plans | $0.30 |
| Geisinger_Medicaid | All_Plans | $0.30 |
| Health_Partners_Medicaid | All_Other_Plans | $0.30 |
| Highmark_Medicare | All_Plans | $0.30 |
| Aetna_Advantra_Medicare | All_Plans | $0.31 |
| Aetna_Medicare | All_Plans | $0.31 |
| Amerihealth_Medicare | All_Plans | $0.32 |
| Highmark_Wholecare_Gateway_Medicare | All_Plans | $0.32 |
| Geisinger_Gold_Medicare | All_Plans | $0.32 |
| Jefferson_Health_Medicare_Advantage | All_Plans | $0.32 |
| PA_Health_&_Wellness_Medicare | All_Plans | $0.32 |
| UPMC_Medicare | UPMC_for_Life_Community_HealthChoices | $0.32 |
| UPMC_Medicare | UPMC_for_Life_Complete_Care | $0.32 |
| Devoted_Medicare | All_Plans | $0.32 |
| United_Medicare | ISNP_DSNP_Plans | $0.32 |
| Blue_Cross | All_Other_Plans | $0.33 |
| Blue_Cross | Capital_Blue_Performance_PPO | $0.33 |
| WellSpan_Capital_Blue_Cross | All_Plans | $0.36 |
| UPMC_Medicaid | All_Plans | $0.36 |
| Highmark | Higmark_Healthy_Kids | $0.47 |
| Health_Partners_Medicaid | Kidz_Partners | $0.49 |
| United_Medicaid | Community_Plan_For_Kids | $0.53 |
| Highmark | Choice_Blue_PPO | $0.91 |
| Highmark | Performance_Blue | $0.91 |
| Highmark | Blue_Cross_High_Performance_Network | $0.91 |
| Aetna | All_Plans | $0.92 |
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