Ketorolac injection, 15 mg at Intermountain Health Good Samaritan Medical Center. CPT J1885.
What Intermountain Health Good Samaritan Medical Center publishes for this service, straight from its standard-charges file, last updated March 22, 2026.
Outpatient / ER
—cash price (self-pay)
$26.59list price
$0.30–$50.00range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $4.92 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $6.12 |
| Kaiser Perm HMO | Kaiser Out Of State | $6.12 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $6.12 |
| Allegiance | Cigna Sclhs Employees | $6.65 |
| Cigna Scl Employees | Cigna Sclhs Cdhp | $6.65 |
| Cigna | Cigna Co Public Option | $6.77 |
| Cigna | Cigna Connect Exchange | $6.77 |
| Cigna | Cigna Surefit | $6.77 |
| Aetna | Aetna Colorado Preferred | $9.89 |
| BCBS/Anthem | BCBS Co Federal | $10.58 |
| BCBS/Anthem | BCBS Co HMO | $10.58 |
| BCBS/Anthem | BCBS Co PPO | $10.58 |
| Aetna | Aetna HMO/EPO | $10.61 |
| Aetna | Aetna Indemnity | $10.61 |
| Aetna | Aetna Other | $10.61 |
| Aetna | Aetna POS/Qpos | $10.61 |
| Aetna | Aetna PPO | $10.61 |
| Aetna | Aetna Src | $10.61 |
| Geha | Geha-Asa | $10.61 |
| Preferred One | Preferred One | $10.61 |
| Choicecare Humana | Choicecare Humana HMO EPO | $11.17 |
| Choicecare Humana | Choicecare Humana PPO | $11.17 |
| Cigna | Cigna HMO | $15.22 |
| Cigna | Cigna Indemnity | $15.22 |
| Cigna | Cigna Local Plus | $15.22 |
| Cigna | Cigna Other | $15.22 |
| Cigna | Cigna POS/Qpos | $15.22 |
| Cigna | Cigna PPO | $15.22 |
| Cigna | Eighth Dist Elect Ben Pln | $15.22 |
Inpatient
—cash price (self-pay)
$26.59list price
$3.07–$55.39range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Kaiser Perm HMO | Kp Select HMO | $7.84 |
| Kaiser Perm HMO | Kaiser HMO Exchange Plan | $11.20 |
| Kaiser Perm HMO | Kaiser Out Of State | $11.20 |
| Kaiser Perm HMO | Kaiser Permanente HMO | $11.20 |
| Kaiser Self Funded | Kaiser Self Funded | $11.20 |
| Kaiser Perm PPO/POS | Kaiser Perm PPO/POS | $11.54 |
| Private Hlthcare Sys | Phcs Other | $19.94 |
| Private Hlthcare Sys | Phcs PPO | $19.94 |
| BCBS/Anthem | BCBS Co Indemnity | $22.38 |
| Multiplan Inc | Multiplan Inc Other | $22.60 |
| Multiplan Inc | Multiplan Inc PPO | $22.60 |
| Aetna | Aetna Nap | $23.85 |
| Cigna | Cigna HMO | $26.59 |
| Cigna | Cigna Indemnity | $26.59 |
| Cigna | Cigna Local Plus | $26.59 |
| Cigna | Cigna Other | $26.59 |
| Cigna | Cigna POS/Qpos | $26.59 |
| Cigna | Cigna PPO | $26.59 |
| Cigna | Eighth Dist Elect Ben Pln | $26.59 |
| Cigna | Health-Partners | $26.59 |
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All common services at Intermountain Health Good Samaritan Medical Center