Ketorolac injection, 15 mg at IHC Health Services Inc., DBA Intermountain Primary Children's Hospital. CPT J1885.
What IHC Health Services Inc., DBA Intermountain Primary Children's Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$11.25cash price (self-pay)
$18.90list price
$0.25–$20.06range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| SelectHealth | Medicaid | $6.00 |
| Donor Connect | Other | $7.52 |
| Aetna | Standard | $15.88 |
| BYU Athletics | Commercial | $15.88 |
| Campbell Scientific | Commercial | $15.88 |
| Cigna | HMO | $15.88 |
| Cigna | Open Access Flex | $15.88 |
| Cigna | PPO/EPO | $15.88 |
| Cigna | Utah Connect/Local Plus | $15.88 |
| Deseret Mutual | All Other | $15.88 |
| EMI Health | Mint | $15.88 |
| EMI Health | Network Care | $15.88 |
| EMI | Commercial | $15.88 |
| First Choice of the Midwest | Commercial | $15.88 |
| First Choice | Commercial | $15.88 |
| Franklin County | Commercial | $15.88 |
| Global Excel | Commercial | $15.88 |
| Health Utah | Commercial | $15.88 |
| Humana | Commercial | $15.88 |
| Hygeia Corporation | Commercial | $15.88 |
| Juniper Systems | Commercial | $15.88 |
| LW Miller | Commercial | $15.88 |
| Managed Care Admin | Commercial | $15.88 |
| MedCare International | Commercial | $15.88 |
| Molina | CHIP | $15.88 |
| Molina | Marketplace | $15.88 |
| MotivHealth | Commercial | $15.88 |
| PEHP | All Plans | $15.88 |
| PEHP | Summit Exclusive | $15.88 |
| Prodegi Corp Benefit | Commercial | $15.88 |
Inpatient
$11.25cash price (self-pay)
$18.90list price
$5.40–$20.06range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $6.81 |
| American Health | Medicare Adv UT HMO I-SNP | $10.78 |
| Molina | Medicare Advantage | $11.34 |
| Molina | Medicare Choice Care HMO | $11.34 |
| Molina | Medicare Complete Care HMO SNP | $11.34 |
| AWH Connected | Connected Utah | $13.42 |
| Aetna | Connected | $13.42 |
| Aetna | Extended | $13.42 |
| Aetna | Standard | $13.42 |
| BYU Athletics | Commercial | $13.42 |
| Campbell Scientific | Commercial | $13.42 |
| Cigna | HMO | $13.42 |
| Cigna | Open Access Flex | $13.42 |
| Cigna | PPO/EPO | $13.42 |
| Cigna | Utah Connect/Local Plus | $13.42 |
| Deseret Mutual | All Other | $13.42 |
| EMI Health | Mint | $13.42 |
| EMI Health | Network Care | $13.42 |
| EMI | Commercial | $13.42 |
| First Choice of the Midwest | Commercial | $13.42 |
| First Choice | Commercial | $13.42 |
| Franklin County | Commercial | $13.42 |
| Global Excel | Commercial | $13.42 |
| Health Utah | Commercial | $13.42 |
| Humana | Commercial | $13.42 |
| Hygeia Corporation | Commercial | $13.42 |
| Juniper Systems | Commercial | $13.42 |
| LW Miller | Commercial | $13.42 |
| Managed Care Admin | Commercial | $13.42 |
| MedCare International | Commercial | $13.42 |
Billed more than this?
Scan my billSnap a photo of your bill. We compare every line with these prices and coding rules, free.
All common services at IHC Health Services Inc., DBA Intermountain Primary Children's Hospital