RxDoctor Payments Data

HCPCS J1745

Injection, infliximab, excludes biosimilar, 10 mg

$31.05Medicare-allowed amount per service, averaged across 5,576,857 services
Providers submitted
$134.50

Asking price, not received

Medicare allowed
$31.05

The fee schedule figure

Medicare paid
$24.57

Balance is patient coinsurance

Providers submitted an average of $134.50 for this code and Medicare allowed $31.054.3× less. That gap is normal and means nothing on its own: Medicare pays its fee schedule regardless of what is billed, so the submitted figure describes a hospital chargemaster, not a price anyone paid. Of the allowed amount Medicare paid $24.57 (79%); the rest is the patient’s coinsurance and deductible.

Services
5,576,857

Medicare Part B, 2024

Beneficiaries
31,833
Providers billing it
1,377
Total allowed
$173,161,410

Services × allowed amount

What Medicare pays for HCPCS J1745

Across 5,576,857 services billed by 1,377 providers to 31,833 beneficiaries, Medicare allowed an average of $31.05 per service. That is 175.2 services per beneficiary, so this is a code patients typically receive more than once. The allowed amount is the figure that matters: it is what Medicare and the patient together owe, set by the fee schedule and adjusted for local practice costs. What a provider chose to submit has no bearing on it.

This is a drug or supply code rather than a service. The unit is usually a dose or a milligram, so the per-service figure is small by construction and the total is what carries meaning — read it alongside the service count rather than on its own.

Who bills J1745

SpecialtyServicesBeneficiariesAvg allowedProviders
Rheumatology3,898,21819,734$31.06736
Nurse Practitioner523,2203,515$30.95180
Gastroenterology480,2124,417$31.19265
Internal Medicine246,9121,439$30.9265
Physician Assistant91,666616$31.1924
Hematology-Oncology87,770668$31.2342
Infectious Disease73,359371$30.8118
Family Practice62,220447$30.4015
Allergy/ Immunology32,460248$31.2612
Pediatric Medicine20,48072$31.373
Hospitalist16,91071$31.443
Neurology13,45047$31.122
Medical Oncology6,34237$30.593
Endocrinology5,73029$31.412
Vascular Surgery4,91028$23.561

J1745 reimbursement by state

Two different numbers. Allowed is what Medicare actually allowed in that state, which includes the local practice-cost adjustment. Standardized strips that geographic adjustment out of the payment, so it is the column to use when comparing states — a difference there reflects how the code was billed, not what it costs to run a practice locally.

StateServicesAllowedStandardized pmtProviders
Texas388,156$30.81$24.84103
Pennsylvania331,749$31.04$24.8791
Florida329,600$31.12$24.88114
North Carolina316,654$31.12$24.8876
New York253,011$31.21$24.8753
California252,917$30.89$24.6160
Virginia235,258$31.12$24.9834
Illinois201,506$31.16$24.9460
Ohio195,062$31.07$24.8939
South Carolina191,278$30.81$24.8842
Oklahoma180,719$30.66$24.9422
Maryland175,467$31.05$24.9545
Colorado175,010$31.32$24.9044
Washington172,899$31.03$24.9240
Arizona166,970$30.92$24.9640
Minnesota166,797$31.22$24.8862
Missouri166,166$31.18$24.7736
Tennessee161,510$30.79$24.9539
New Jersey157,607$30.99$25.0331
Wisconsin105,002$31.21$24.8517
Alabama104,310$31.01$24.9827
Nebraska102,490$31.36$24.8440
Georgia100,017$31.07$24.8026
Oregon92,480$31.32$24.8420
Iowa81,740$31.40$24.8222
Massachusetts79,098$30.20$24.9319
Kansas76,300$31.18$24.8421
Michigan75,350$31.37$24.8926
Indiana72,103$31.17$24.9417
Kentucky69,037$30.75$24.8312
Mississippi60,379$30.93$24.9718
Delaware44,555$31.43$24.908
Arkansas40,474$31.16$24.8813
Idaho34,477$31.27$24.906
Utah30,872$31.11$24.947
Alaska26,663$30.84$25.143
Louisiana26,293$31.03$24.927
Nevada20,220$31.04$24.964
Connecticut19,610$31.42$24.887
New Mexico15,742$30.70$25.026
South Dakota13,370$31.43$24.923
Wyoming12,460$31.41$24.881
Rhode Island11,415$30.81$24.924
New Hampshire9,760$31.42$24.992
Montana9,370$31.44$24.784
Maine9,230$31.41$24.802
District of Columbia6,290$31.07$24.992
Vermont5,132$31.42$24.731
Hawaii4,280$31.43$24.801

Related codes

Billing this code is not the same as earning it

An allowed amount is revenue to a practice, not income to a clinician. It funds staff, premises, equipment and supplies before anyone is paid. What clinicians actually earn is published separately by the Department of Labor, and what industry pays them is published separately again by CMS — this site carries both.

What doctors are paid →·Look up a clinician →·All procedure codes →

Where this comes from. CMS Medicare Physician & Other Practitioners, by Provider and Service, 2024. It covers fee-for-service Original Medicare Part B only — not Medicare Advantage, not Medicaid, and not commercial insurance, which typically pays more for the same code.

How it is averaged. CMS publishes one average per provider per code. Every figure here is re-weighted by the number of services, so a clinician who billed the code 4,000 times counts 4,000 times more than one who billed it twice. CMS also suppresses any provider-code pair with fewer than 11 beneficiaries, so low-volume practice is missing from these totals by design.