Ketorolac injection, 15 mg at Intermountain Health Sanpete Valley Hospital. CPT J1885.
What Intermountain Health Sanpete Valley Hospital publishes for this service, straight from its standard-charges file, last updated August 5, 2026.
Outpatient / ER
$10.72cash price (self-pay)
$14.91list price
$0.59–$14.91range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Health Plan of Nevada | Medicaid | $2.23 |
| Molina | Medicaid | $2.23 |
| SelectHealth | Medicaid | $2.23 |
| Aetna | Medicare Adv HMO | $2.44 |
| Aetna | Medicare Adv PPO | $2.44 |
| American Health | Medicare Adv UT HMO I-SNP | $2.44 |
| Health Partners of Nevada | Medicare Advantage | $2.44 |
| Healthy U | Medicaid | $2.44 |
| Humana | Medicare Choice PPO | $2.44 |
| Molina | Medicare Advantage | $2.44 |
| Molina | Medicare Complete Care HMO SNP | $2.44 |
| Regence BCBS | MedAdvantage PPO | $2.44 |
| SelectHealth | Medicare Advantage | $2.44 |
| UHC | Medicare Advantage | $2.44 |
| Injury Care of Nevada | Workers Comp | $11.19 |
| BYU Risk Management | Workers Comp | $12.68 |
| CorVel Corporation | Workers Comp | $12.68 |
| Corporation of the President | Workers Comp | $12.68 |
| AG Administrators | USU Athletics | $14.16 |
| Aetna | Standard | $14.16 |
| BYU Athletics | Commercial | $14.16 |
| Campbell Scientific | Commercial | $14.16 |
| Cigna | HMO | $14.16 |
| Cigna | Open Access Flex | $14.16 |
| Cigna | PPO/EPO | $14.16 |
| Deseret Mutual | Commercial | $14.16 |
| EMI Health | Mint | $14.16 |
| EMI Health | Network Care | $14.16 |
| EMI | Commercial | $14.16 |
| Franklin County | Commercial | $14.16 |
Inpatient
$10.72cash price (self-pay)
$14.91list price
$10.72–$14.75range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Injury Care of Nevada | Workers Comp | $11.19 |
| BYU Risk Management | Workers Comp | $12.68 |
| CorVel Corporation | Workers Comp | $12.68 |
| Corporation of the President | Workers Comp | $12.68 |
| Health Plan of Nevada | Medicaid | $13.27 |
| Healthy U | Medicaid | $13.27 |
| Molina | Medicaid | $13.27 |
| AG Administrators | USU Athletics | $14.16 |
| AWH Connected | Connected Utah | $14.16 |
| Aetna | Connected | $14.16 |
| Aetna | Extended | $14.16 |
| Aetna | Standard | $14.16 |
| BYU Athletics | Commercial | $14.16 |
| Campbell Scientific | Commercial | $14.16 |
| Cigna | HMO | $14.16 |
| Cigna | Open Access Flex | $14.16 |
| Cigna | PPO/EPO | $14.16 |
| Deseret Mutual | Commercial | $14.16 |
| EMI Health | Mint | $14.16 |
| EMI Health | Network Care | $14.16 |
| EMI | Commercial | $14.16 |
| Franklin County | Commercial | $14.16 |
| Global Excel | Commercial | $14.16 |
| Health Utah | Commercial | $14.16 |
| Humana | Commercial | $14.16 |
| Hygeia Corporation | Commercial | $14.16 |
| Intermountain Caregiver Plan | Med Network | $14.16 |
| Juniper Systems | Commercial | $14.16 |
| LW Miller | Commercial | $14.16 |
| Managed Care Admin | Commercial | $14.16 |
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All common services at Intermountain Health Sanpete Valley Hospital