Ketorolac injection, 15 mg at SSM Health St. Agnes Hospital - Fond du Lac. CPT J1885.
What SSM Health St. Agnes Hospital - Fond du Lac publishes for this service, straight from its standard-charges file, last updated April 1, 2026.
Outpatient / ER
—cash price (self-pay)
—list price
$0.21–$2.05range insurers pay
| Insurance plan | Negotiated rate |
|---|---|
| MOLINA | Medicare Managed Care Plan | $0.21 |
| BCBS | Anthem Medicare Managed Care Plan | $0.29 |
| Wellcare | Medicare Managed Care Plan | $0.29 |
| BCBS | Blue Preferred / Blue Preferred Plus HMO/POS | $0.55 |
| DOC | Government | $0.55 |
| Centivo | Broad(WI1) Other Commercial Plan | $0.66 |
| Centivo | Median(WI2) Other Commercial Plan | $0.66 |
| Centivo | Value(WI3) Other Commercial Plan | $0.66 |
| Health Payment System | All Commercial Plans | $0.81 |
| The Alliance | All Commercial Plans | $1.39 |
| UnitedHealthCare | All Commercial Plans | $2.05 |
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All common services at SSM Health St. Agnes Hospital - Fond du Lac