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
$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 |
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All common services at Intermountain Health Primary Children's Hospital