Ketorolac injection, 15 mg at Gundersen Moundview Hospital and Clinics. CPT J1885.
What Gundersen Moundview Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$1.19cash price (self-pay)
$20.00list price
$0.33–$19.40range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | Self Funded | $0.33 |
| Quartz | All Products | $0.33 |
| Quartz | All Other Self Funded | $0.33 |
| Quartz | Level Funded | $0.33 |
| Quartz | Fully Insured | $0.33 |
| Anthem | State Specific | $0.38 |
| Anthem | HMO/POS | $0.38 |
| Anthem | PPO | $0.38 |
| Alliance | Premier/All Products | $1.07 |
| Alliance | Comprehensive/All Products | $1.07 |
| Security Health Plan | Medicare Advantage | $9.20 |
| Anthem | Medicare HMO/PPO | $9.20 |
| Health Partners | Medicare Advantage | $9.20 |
| Quartz | Medicare Advantage | $9.20 |
| Security Health Plan | Medicare + Choice | $9.20 |
| UCARE | Dually Eligible | $9.20 |
| UCARE | MSHO/Minnesota Special Needs | $9.60 |
| UCARE | Non-Dually Eligible | $9.60 |
| Health Partners | Medicaid HMO | $10.00 |
| Health Partners | Medicare Cost | $12.00 |
| Cigna | All Products | $15.42 |
| WPS | All Products | $15.42 |
| WPS - ARISE | All Products | $15.42 |
| Dean Health Plan | ASO | $15.71 |
| Group Health of South Central | All Products | $16.00 |
| Trilogy | All Products | $16.00 |
| UCARE | Qualified Health Plan | $16.00 |
| Aspirus Arise Health | All Products | $16.60 |
| Sana | All Products | $17.20 |
| Multiplan/Healtheos | Mpi_phcs_healtheos | $17.60 |
Inpatient
$1.19cash price (self-pay)
$20.00list price
$1.08–$19.40range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $11.78 |
| Anthem | State Specific | $14.53 |
| Anthem | HMO/POS | $14.53 |
| Anthem | PPO | $14.53 |
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All common services at Gundersen Moundview Hospital and Clinics