Injection, Ketorolac Tromethamine, Per 15 Mg
What Medicare pays for J1885, what providers bill, and how the price varies across 54 states, drawn from CMS 2023 claims data.
J1885 · the short answer
For injection, ketorolac tromethamine, per 15 mg, Medicare pays about $0.39 on average across 54 states. This is a low-payment administrative or drug code, so the billed-to-paid ratio is not a meaningful "markup."
- Medicare pays
- $0.39
- Providers bill
- $13.18
- States with data
- 54
Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.
Price Range Across States
What You Might Pay
Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.
How we estimate these prices
These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Drugs (Administered) procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.
Prices by State
| State | Medicare Payment | Billed Charge |
|---|---|---|
| Rhode Island | $0.42 | $9.61 |
| New York | $0.42 | $20.95 |
| Connecticut | $0.41 | $16.83 |
| Florida | $0.41 | $11.11 |
| California | $0.41 | $15.60 |
| New Jersey | $0.41 | $23.80 |
| Alaska | $0.40 | $15.37 |
| Massachusetts | $0.40 | $15.42 |
| Wisconsin | $0.40 | $16.92 |
| Maryland | $0.40 | $9.62 |
| Illinois | $0.40 | $13.86 |
| Nevada | $0.40 | $43.03 |
| Minnesota | $0.40 | $7.00 |
| Virginia | $0.40 | $16.75 |
| Nebraska | $0.39 | $7.34 |
| Arizona | $0.39 | $13.95 |
| Michigan | $0.39 | $12.24 |
| Pennsylvania | $0.39 | $9.74 |
| Kansas | $0.39 | $11.32 |
| North Carolina | $0.39 | $10.45 |
| Delaware | $0.39 | $17.58 |
| Texas | $0.39 | $13.67 |
| Colorado | $0.39 | $7.59 |
| Oregon | $0.39 | $6.04 |
| Hawaii | $0.39 | $13.67 |
| South Carolina | $0.39 | $11.86 |
| Utah | $0.39 | $10.44 |
| Iowa | $0.39 | $6.44 |
| Missouri | $0.39 | $10.29 |
| Ohio | $0.39 | $12.65 |
| Louisiana | $0.39 | $11.41 |
| Maine | $0.39 | $6.50 |
| Indiana | $0.39 | $11.43 |
| New Mexico | $0.39 | $12.27 |
| Washington | $0.38 | $8.71 |
| Oklahoma | $0.38 | $10.96 |
| Tennessee | $0.38 | $12.28 |
| Kentucky | $0.38 | $11.48 |
| Georgia | $0.38 | $12.04 |
| Mississippi | $0.38 | $10.96 |
| District of Columbia | $0.38 | $7.93 |
| Idaho | $0.38 | $6.49 |
| Arkansas | $0.38 | $9.79 |
| Montana | $0.38 | $5.81 |
| North Dakota | $0.38 | $9.70 |
| Alabama | $0.38 | $10.77 |
| U.S. Virgin Islands | $0.38 | $22.42 |
| Puerto Rico | $0.37 | $8.29 |
| West Virginia | $0.37 | $11.56 |
| South Dakota | $0.37 | $7.44 |
| New Hampshire | $0.37 | $7.29 |
| Wyoming | $0.37 | $11.48 |
| Vermont | $0.35 | $13.46 |
| Guam | $0.29 | $7.02 |
What the Data Says About Injection, Ketorolac Tromethamine, Per 15 Mg
Across 54 states with reporting providers, CPT code J1885 (Injection, Ketorolac Tromethamine, Per 15 Mg) shows a national average Medicare payment of $0.39 against an average billed charge of $13.18. That gap, a 33.5x markup, or 3247% above the Medicare allowed amount, is not a meaningful ratio for this low-payment code, so treat the billed figure as a chargemaster reference point rather than a real-world price.
Drugs (Administered) procedures like this one saw 1.7M services billed to Medicare in 2023 by 75.9K distinct providers, serving 385.8K unique beneficiaries. State-level variation is significant: Guam reports the lowest average payment at $0.29, while Rhode Island reports the highest at $0.42. The 45% spread here is a moderate, fairly ordinary GPCI effect, local cost-of-practice adjustments nudging the allowed amount up or down without reshaping it.
Applying RAND 2024 commercial-to-Medicare ratios specific to the Drugs (Administered) category (2.24x), the estimated commercial insurance price lands near $1.21, with self-pay cash discounts commonly bringing the figure closer to $4.03. Within Drugs (Administered), Injection, Ketorolac Tromethamine, Per 15 Mg ranks #479 of 530 tracked procedures by national average Medicare payment.
What to do with this
If you may have injection, ketorolac tromethamine, per 15 mg done, these steps turn the numbers above into a real-world cost estimate.
- Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
- Compare injection, ketorolac tromethamine, per 15 mg costs in your state, Medicare rates vary by locality. Browse states
- Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
- Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide
Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.
Frequently Asked Questions
How much does Injection, Ketorolac Tromethamine, Per 15 Mg cost?
Medicare's national average payment for Injection, Ketorolac Tromethamine, Per 15 Mg (CPT J1885) is $0.39, with providers billing $13.18 on average; state rates run from $0.29 to $0.42, a meaningful but not extreme spread.
Why do providers charge more than Medicare pays?
Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.
How much does Injection, Ketorolac Tromethamine, Per 15 Mg cost with insurance?
With commercial insurance, injection, ketorolac tromethamine, per 15 mg costs an estimated $1.21 on average (range: $0.85-$1.69), a moderate premium over Medicare's $0.39. Without insurance, the estimated cash price is $4.03.
Which state has the lowest cost for Injection, Ketorolac Tromethamine, Per 15 Mg?
Guam has the lowest average Medicare payment for Injection, Ketorolac Tromethamine, Per 15 Mg at $0.29, while Rhode Island has the highest at $0.42 - a meaningful $0.13 spread.
How many providers perform Injection, Ketorolac Tromethamine, Per 15 Mg?
Injection, Ketorolac Tromethamine, Per 15 Mg is a widely-performed procedure: 75.9K providers billed Medicare for it in 2023 across 54 states, together handling 1.7M services for 385.8K beneficiaries.
What is the billed-to-Medicare markup for Injection, Ketorolac Tromethamine, Per 15 Mg?
Providers bill 33.5x what Medicare pays for Injection, Ketorolac Tromethamine, Per 15 Mg - a markup within the typical range at 3247% above the Medicare rate.
Related Guides
Tips to reduce out-of-pocket costs
Your right to upfront pricing
How Medicare payments work
Decode charges and codes
Why bills exceed actual costs
Geographic pricing factors
Data from CMS Medicare Physician & Other Practitioners (2023).
Read our methodology - how this data is sourced, computed, and verified.
Related
Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.