Ketorolac injection, 15 mg at Intermountain Health Primary Children's Hospital. CPT J1885.
What Intermountain Health Primary Children's Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$4.44cash price (self-pay)
$15.00list price
$0.25–$20.06range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| SelectHealth | Medicaid | $2.37 |
| Donor Connect | Other | $5.97 |
| Aetna | Standard | $12.60 |
| BYU Athletics | Commercial | $12.60 |
| Campbell Scientific | Commercial | $12.60 |
| Cigna | HMO | $12.60 |
| Cigna | Open Access Flex | $12.60 |
| Cigna | PPO/EPO | $12.60 |
| Cigna | Utah Connect/Local Plus | $12.60 |
| Deseret Mutual | All Other | $12.60 |
| EMI Health | Mint | $12.60 |
| EMI Health | Network Care | $12.60 |
| EMI | Commercial | $12.60 |
| First Choice of the Midwest | Commercial | $12.60 |
| First Choice | Commercial | $12.60 |
| Franklin County | Commercial | $12.60 |
| Global Excel | Commercial | $12.60 |
| Health Utah | Commercial | $12.60 |
| Humana | Commercial | $12.60 |
| Hygeia Corporation | Commercial | $12.60 |
| Juniper Systems | Commercial | $12.60 |
| LW Miller | Commercial | $12.60 |
| Managed Care Admin | Commercial | $12.60 |
| MedCare International | Commercial | $12.60 |
| Molina | CHIP | $12.60 |
| Molina | Marketplace | $12.60 |
| MotivHealth | Commercial | $12.60 |
| PEHP | All Plans | $12.60 |
| PEHP | Summit Exclusive | $12.60 |
| Prodegi Corp Benefit | Commercial | $12.60 |
Inpatient
$4.44cash price (self-pay)
$15.00list price
$2.13–$20.06range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Donor Connect | Other | $5.40 |
| American Health | Medicare Adv UT HMO I-SNP | $8.55 |
| Molina | Medicare Advantage | $9.00 |
| Molina | Medicare Choice Care HMO | $9.00 |
| Molina | Medicare Complete Care HMO SNP | $9.00 |
| AWH Connected | Connected Utah | $10.65 |
| Aetna | Connected | $10.65 |
| Aetna | Extended | $10.65 |
| Aetna | Standard | $10.65 |
| BYU Athletics | Commercial | $10.65 |
| Campbell Scientific | Commercial | $10.65 |
| Cigna | HMO | $10.65 |
| Cigna | Open Access Flex | $10.65 |
| Cigna | PPO/EPO | $10.65 |
| Cigna | Utah Connect/Local Plus | $10.65 |
| Deseret Mutual | All Other | $10.65 |
| EMI Health | Mint | $10.65 |
| EMI Health | Network Care | $10.65 |
| EMI | Commercial | $10.65 |
| First Choice of the Midwest | Commercial | $10.65 |
| First Choice | Commercial | $10.65 |
| Franklin County | Commercial | $10.65 |
| Global Excel | Commercial | $10.65 |
| Health Utah | Commercial | $10.65 |
| Humana | Commercial | $10.65 |
| Hygeia Corporation | Commercial | $10.65 |
| Juniper Systems | Commercial | $10.65 |
| LW Miller | Commercial | $10.65 |
| Managed Care Admin | Commercial | $10.65 |
| MedCare International | Commercial | $10.65 |
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All common services at Intermountain Health Primary Children's Hospital