Ketorolac injection, 15 mg at Froedtert Holy Family Memorial Hospital. CPT J1885.
What Froedtert Holy Family Memorial Hospital publishes for this service, straight from its standard-charges file, last updated December 31, 2025.
Outpatient / ER
$19.78cash price (self-pay)
$36.81list price
$0.29–$33.16range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Allwell | Medicare Advantage | $0.29 |
| Anthem Blue Cross Blue Shield | Medicare Advantage | $0.29 |
| Community Care Incorporated | Medicare Advantage | $0.29 |
| Health Partners | Medicare Advantage | $0.29 |
| Humana | Medicare Advantage | $0.29 |
| ICare | Medicare Advantage | $0.29 |
| Molina | Medicare Advantage | $0.29 |
| Network Health Plan | Medicare Advantage | $0.29 |
| Security Health Plan | Medicare Advantage | $0.29 |
| United Healthcare | Medicare Advantage | $0.29 |
| Molina | Marketplace Plans | $0.31 |
| Anthem Blue Cross Blue Shield (Healthlink) | HMO/PPO | $0.47 |
| Network Health Plan | HMO | $0.80 |
| United Healthcare | Manitowoc Schools | $0.80 |
| United Healthcare | Nexus | $0.80 |
| United Healthcare Choice/Navigate | APA | $0.80 |
| United Healthcare Options | PPO | $0.80 |
| Medical College of Wisconsin | Employee Plan | $12.14 |
| Centivo | WI 2 Median | $14.73 |
| Centivo | WI 1 Broad | $16.93 |
| Dean Health Plan | All Plans | $17.98 |
| Network Health Plan | ACA | $20.24 |
| Health Payment Systems | All Contracted Commercial Plans | $20.77 |
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $22.09 |
| Chorus Community Health Plan | Marketplace Plans | $23.68 |
| Health Partners | All Contracted Commercial Plans | $23.93 |
| Trilogy | All Contracted Commercial Plans | $24.30 |
| Cigna | All Contracted Commercial Plans | $26.50 |
| WPS Health Plan | All Contracted Commercial Plans | $27.24 |
| Aspirus | Marketplace Plans | $29.45 |
Inpatient
$19.78cash price (self-pay)
$36.81list price
$17.98–$33.16range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Anthem Blue Cross Blue Shield (Healthlink) | HMO/PPO | $18.41 |
| Sheboygan Employers Health Network | All Contracted Commercial Plans | $22.09 |
| Trilogy | All Contracted Commercial Plans | $24.30 |
| Cigna | All Contracted Commercial Plans | $26.50 |
| Aspirus | Marketplace Plans | $29.45 |
| HealthEos | All Contracted Commercial Plans | $29.45 |
| Multiplan/Private Healthcare Systems | All Contracted Commercial Plans | $29.45 |
| Preferred One | All Contracted Commercial Plans | $29.45 |
| Security Health Plan | All Contracted Commercial Plans | $29.45 |
| HealthSmart | All Contracted Commercial Plans | $30.55 |
| First Health Network | All Contracted Commercial Plans | $32.40 |
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All common services at Froedtert Holy Family Memorial Hospital