Ketorolac injection, 15 mg at Gundersen TriCounty Hospital and Clinics. CPT J1885.
What Gundersen TriCounty Hospital and Clinics publishes for this service, straight from its standard-charges file, last updated June 27, 2026.
Outpatient / ER
$12.68cash price (self-pay)
$20.00list price
$0.33–$19.00range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Products | $0.33 |
| Quartz | All Other Self Funded | $0.33 |
| Quartz | Level Funded | $0.33 |
| Quartz | Self Funded | $0.33 |
| Quartz | Fully Insured | $0.33 |
| Anthem | State Specific | $0.38 |
| Anthem | PPO | $0.38 |
| Anthem | HMO/POS | $0.38 |
| Alliance | Premier/All Products | $3.48 |
| Alliance | Comprehensive/All Products | $3.75 |
| UCARE | Non-Dually Eligible | $10.40 |
| UCARE | MSHO/Minnesota Special Needs | $10.40 |
| UCARE | Dually Eligible | $10.40 |
| Anthem | Medicare HMO/PPO | $11.80 |
| Humana | Medicare Advantage | $11.80 |
| Quartz | Medicare Advantage | $11.80 |
| UHC | Medicare Advantage | $11.80 |
| UHC | All Payer Appendix | $14.40 |
| Cigna | All Products | $15.42 |
| 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 |
| Allied National | Core Value Programs | $17.00 |
| Sana | All Products | $17.20 |
| Group Health Eau Claire | All Products | $18.00 |
| Coventry Health Care | All Products | $19.00 |
| WPS | All Products | $19.00 |
| WPS - ARISE | All Products | $19.00 |
Inpatient
$12.68cash price (self-pay)
$20.00list price
$10.40–$19.00range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| Quartz | All Other Self Funded | $11.78 |
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All common services at Gundersen TriCounty Hospital and Clinics