Ketorolac injection, 15 mg at Holy Cross Hospital - Davis. CPT J1885.
What Holy Cross Hospital - Davis publishes for this service, straight from its standard-charges file, last updated February 11, 2026.
Outpatient / ER
$36.00cash price (self-pay)
$90.00list price
$0.30–$108range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Humana | Managed Medicare | $0.30 |
| Managed Medicaid | Managed Medicaid | $0.30 |
| Managed Medicare | Managed Medicare | $0.30 |
| Medicare | Medicare | $0.30 |
| UUHP | Managed Medicaid | $0.30 |
| Employer Direct Healthcare | Commercial PPO/POS/HMO | $0.37 |
| MotivHealth | Commercial PPO/POS/HMO | $0.39 |
| Molina | Commercial PPO/POS/HMO | $0.63 |
| Cigna Healthcare | Commercial All Other | $1.19 |
| Centura Employee Plan | Commercial PPO/POS/HMO/EPO | $31.50 |
| Cigna Healthcare | Commercial Local Plus | $32.19 |
| PEHP | Commercial Capital Network | $38.43 |
| Aetna | Commercial Peak Performance | $39.76 |
| PEHP | Commercial Summit Exclusive | $42.57 |
| Select Health | Commercial PPO/POS/HMO | $44.24 |
| UUHP | Commercial Health Plus | $44.37 |
| UUHP | Commercial Healthy Preferred | $44.37 |
| Cigna Healthcare | Commercial HMO/NBP/OAP | $45.18 |
| PEHP | Commercial Summit | $45.81 |
| Wise | Commercial PPO | $46.80 |
| Aetna | Commercial Standard Network | $47.43 |
| UUHP | Commercial Healthy Premier | $48.78 |
| Regence Blue Cross Blue Shield | Commercial Blue Option | $49.95 |
| PEHP | Commercial Advantage | $52.20 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $55.26 |
| Multiplan | Commercial Primary | $62.10 |
| United Healthcare | Commercial PPO/POS/HMO | $65.25 |
| Aetna | Commercial Signature | $65.41 |
| Aetna | Commercial Extended Network | $67.50 |
| Aetna | Commercial Indemnity | $72.00 |
Inpatient
$36.00cash price (self-pay)
$90.00list price
$31.50–$108range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Centura Employee Plan | Commercial PPO/POS/HMO/EPO | $31.50 |
| Regence Blue Cross Blue Shield | Commercial Savewell | $33.47 |
| PEHP | Commercial Capital Network | $38.43 |
| Molina | Commercial PPO/POS/HMO | $38.65 |
| Aetna | Commercial Peak Performance | $39.76 |
| Regence Blue Cross Blue Shield | Commercial UVU | $41.24 |
| PEHP | Commercial Summit Exclusive | $42.57 |
| Select Health | Commercial PPO/POS/HMO | $44.24 |
| PEHP | Commercial Summit | $45.81 |
| Aetna | Commercial Standard Network | $47.43 |
| Wise | Commercial PPO | $47.70 |
| Regence Blue Cross Blue Shield | Commercial PPO | $48.51 |
| United Healthcare | Commercial PPO/POS/HMO | $52.02 |
| PEHP | Commercial Advantage | $52.20 |
| Multiplan | Commercial Primary | $53.10 |
| Regence Blue Cross Blue Shield | Commercial Blue Option | $54.00 |
| Regence Blue Cross Blue Shield | Commercial PAR | $54.00 |
| Deseret Mutual Benefit Administrators | Commercial PPO/POS/HMO | $55.26 |
| Aetna | Commercial Signature | $65.41 |
| Aetna | Commercial Extended Network | $67.50 |
| Aetna | Commercial Indemnity | $72.00 |
| Aetna Rental Networks | Commercial PPO/POS/HMO | $76.05 |
| EMI Health | Commercial PPO/POS/HMO | $78.30 |
| Multiplan | Commercial Complementary | $81.90 |
| United Healthcare | Commercial Behavioral Health | $90.00 |
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