Drugs codes J1000 to J1980 with Medicaid rates by state

194 drugs codes from J1000 to J1980 carry a published Medicaid rate in ten or more states. The median shown is across those states' unmodified published rates; open a code for the full state-by-state table with percent of Medicare and prior-authorization flags.

CodeDescriptionStatesMedian rate
J1000Injection, depo-estradiol cypionate, up to 5 mg30$53.81
J1010Injection, methylprednisolone acetate, 1 mg30$0.12
J1050Injection, medroxyprogesterone acetate, 1 mg30$0.46
J1071Injection, testosterone cypionate, 1 mg28$0.03
J1072Injection, testosterone cypionate (azmiro), 1 mg23$1.30
J1073Testosterone pellet, implant, 75 mg18$108.18
J1095Injection, dexamethasone 9 percent, intraocular, 1 microgram13$1.18
J1096Dexamethasone, lacrimal ophthalmic insert, 0.1 mg27$91.30
J1097Phenylephrine 10.16 mg/ml and ketorolac 2.88 mg/ml ophthalmic irrigation solution, 1 ml21$116.25
J1100Injection, dexamethasone sodium phosphate, 1 mg31$0.09
J1105Dexmedetomidine, oral, 1 mcg15$0.65
J1110Injection, dihydroergotamine mesylate, per 1 mg29$54.98
J1120Injection, acetazolamide sodium, up to 500 mg29$28.13
J1130Injection, diclofenac sodium, 0.5 mg10$0.21
J1160Injection, digoxin, up to 0.5 mg30$3.99
J1162Injection, digoxin immune fab (ovine), per vial23$5,166.99
J1163Injection, diltiazem hydrochloride, 0.5 mg22$0.03
J1164Injection, diltiazem hydrochloride in 0.72% sodium chloride, 0.5 mg17$0.18
J1165Injection, phenytoin sodium, per 50 mg29$0.55
J1171Injection, hydromorphone, 0.1 mg26$0.13
J1180Injection, dyphylline, up to 500 mg10$8.05
J1190Injection, dexrazoxane hydrochloride, per 250 mg32$49.93
J1200Injection, diphenhydramine hcl, up to 50 mg30$0.75
J1201Injection, cetirizine hydrochloride, 0.5 mg21$17.09
J1202Miglustat, oral, 65 mg16$35.50
J1203Injection, cipaglucosidase alfa-atga, 5 mg27$92.40
J1205Injection, chlorothiazide sodium, per 500 mg29$77.77
J1212Injection, dmso, dimethyl sulfoxide, 50%, 50 ml28$748.87
J1230Injection, methadone hcl, up to 10 mg25$12.71
J1240Injection, dimenhydrinate, up to 50 mg29$8.64
J1245Injection, dipyridamole, per 10 mg29$8.41
J1250Injection, dobutamine hydrochloride, per 250 mg31$7.69
J1260Injection, dolasetron mesylate, 10 mg16$6.17
J1265Injection, dopamine hcl, 40 mg26$0.80
J1270Injection, doxercalciferol, 1 mcg28$0.33
J1271Injection, doxycycline hyclate, 1 mg25$0.09
J1289Injection, narsoplimab-wuug, 1 mg14$99.47
J1290Injection, ecallantide, 1 mg31$579.86
J1299Injection, eculizumab, 2 mg24$44.27
J1301Injection, edaravone, 1 mg29$15.18
J1302Injection, sutimlimab-jome, 10 mg28$19.03
J1303Injection, ravulizumab-cwvz, 10 mg31$224.80
J1304Injection, tofersen, 1 mg29$160.01
J1305Injection, evinacumab-dgnb, 5mg30$197.17
J1306Injection, inclisiran, 1 mg29$12.90
J1307Injection, crovalimab-akkz, 10 mg27$551.51
J1308Injection, famotidine, 0.25 mg22$0.01
J1320Injection, amitriptyline hcl, up to 20 mg10$2.24
J1322Injection, elosulfase alfa, 1 mg31$311.94
J1323Injection, elranatamab-bcmm, 1 mg29$188.52
J1324Injection, enfuvirtide, 1 mg18$0.66
J1325Injection, epoprostenol, 0.5 mg28$16.91
J1326Injection, zolbetuximab-clzb, 2 mg27$33.67
J1327Injection, eptifibatide, 5 mg24$10.68
J1335Injection, ertapenem sodium, 500 mg29$7.22
J1364Injection, erythromycin lactobionate, per 500 mg30$131.85
J1370Injection, esomeprazole sodium, 1 mg13$0.21
J1380Injection, estradiol valerate, up to 10 mg29$7.70
J1410Injection, estrogen conjugated, per 25 mg31$392.06
J1411Injection, etranacogene dezaparvovec-drlb, per therapeutic dose10$3,500,000.00
J1412Injection, valoctocogene roxaparvovec-rvox, per ml, containing nominal 2 x 10^13 vector genomes14$11,843.13
J1413Injection, delandistrogene moxeparvovec-rokl, per therapeutic dose11$3,200,000.00
J1426Injection, casimersen, 10 mg22$161.83
J1427Injection, viltolarsen, 10 mg21$56.40
J1428Injection, eteplirsen, 10 mg22$161.83
J1429Injection, golodirsen, 10 mg20$160.00
J1430Injection, ethanolamine oleate, 100 mg25$517.08
J1434Injection, fosaprepitant (focinvez), 1 mg28$2.55
J1435Injection, estrone, per 1 mg11$0.25
J1436Injection, etidronate disodium, per 300 mg11$71.41
J1437Injection, ferric derisomaltose, 10 mg29$21.34
J1438Injection, etanercept, 25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)25$867.43
J1439Injection, ferric carboxymaltose, 1 mg33$1.13
J1440Fecal microbiota, live - jslm, 1 ml28$64.63
J1442Injection, filgrastim (g-csf), excludes biosimilars, 1 microgram32$1.00
J1447Injection, tbo-filgrastim, 1 microgram32$0.25
J1448Injection, trilaciclib, 1mg29$5.42
J1449Injection, eflapegrastim-xnst, 0.1 mg32$35.43
J1450Injection fluconazole, 200 mg29$6.10
J1451Injection, fomepizole, 15 mg26$7.82
J1453Injection, fosaprepitant, 1 mg30$0.12
J1454Injection, fosnetupitant 235 mg and palonosetron 0.25 mg32$524.18
J1455Injection, foscarnet sodium, per 1000 mg32$8.36
J1456Injection, fosaprepitant (teva), not therapeutically equivalent to j1453, 1 mg27$0.56
J1458Injection, galsulfase, 1 mg30$513.86
J1459Injection, immune globulin (privigen), intravenous, non-lyophilized (e.g., liquid), 500 mg32$50.28
J1460Injection, gamma globulin, intramuscular, 1 cc32$48.87
J1551Injection, immune globulin (cutaquig), 100 mg29$14.03
J1552Injection, immune globulin (alyglo), 500 mg27$123.73
J1553Injection, immune globulin (yimmugo), 100 mg14$24.15
J1554Injection, immune globulin (asceniv), 500 mg30$492.72
J1555Injection, immune globulin (cuvitru), 100 mg31$17.58
J1556Injection, immune globulin (bivigam), 500 mg33$79.44
J1557Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg32$64.29
J1558Injection, immune globulin (xembify), 100 mg30$15.24
J1559Injection, immune globulin (hizentra), 100 mg31$14.88
J1560Injection, gamma globulin, intramuscular, over 10 cc29$162.52
J1561Injection, immune globulin, (gamunex-c/gammaked), non-lyophilized (e.g., liquid), 500 mg33$49.01
J1566Injection, immune globulin, intravenous, lyophilized (e.g., powder), not otherwise specified, 500 mg32$80.96
J1568Injection, immune globulin, (octagam), intravenous, non-lyophilized (e.g., liquid), 500 mg33$47.06
J1569Injection, immune globulin, (gammagard liquid/gammagard liquid erc), 500 mg33$49.19
J1570Injection, ganciclovir sodium, 500 mg29$31.46
J1571Injection, hepatitis b immune globulin (hepagam b), intramuscular, 0.5 ml32$65.61
J1572Injection, immune globulin, (flebogamma/flebogamma dif), intravenous, non-lyophilized (e.g., liquid), 500 mg22$55.86
J1573Injection, hepatitis b immune globulin (hepagam b), intravenous, 0.5 ml29$65.61
J1574Injection, ganciclovir sodium (exela), not therapeutically equivalent to j1570, 500 mg16$50.00
J1575Injection, immune globulin/hyaluronidase, (hyqvia), 100 mg immuneglobulin34$18.34
J1576Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg30$71.35
J1577Injection, immune globulin (qivigy), 100 mg15$28.72
J1580Injection, garamycin, gentamicin, up to 80 mg31$1.93
J1595Injection, glatiramer acetate, 20 mg19$67.64
J1596Injection, glycopyrrolate, 0.1 mg27$0.38
J1597Injection, glycopyrrolate (glyrx-pf), 0.1 mg22$1.32
J1598Injection, glycopyrrolate (fresenius kabi), not therapeutically equivalent to j1596, 0.1 mg25$1.34
J1599Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg11$115.01
J1600Injection, gold sodium thiomalate, up to 50 mg14$26.02
J1602Injection, golimumab, 1 mg, for intravenous use31$11.04
J1610Injection, glucagon hydrochloride, per 1 mg30$121.76
J1611Injection, glucagon hydrochloride (fresenius kabi), not therapeutically equivalent to j1610, per 1 mg29$135.00
J1612Injection, glucagon (gvoke), 0.01 mg18$2.34
J1626Injection, granisetron hydrochloride, 100 mcg31$0.20
J1627Injection, granisetron, extended-release, 0.1 mg32$3.98
J1628Injection, guselkumab, 1 mg28$72.61
J1630Injection, haloperidol, up to 5 mg28$0.75
J1631Injection, haloperidol decanoate, per 50 mg30$5.29
J1632Injection, brexanolone, 1 mg15$74.98
J1640Injection, hemin, 1 mg30$35.31
J1642Injection, heparin sodium, (heparin lock flush), per 10 units24$0.02
J1643Injection, heparin sodium (pfizer), not therapeutically equivalent to j1644, per 1000 units26$1.71
J1644Injection, heparin sodium, per 1000 units29$0.20
J1645Injection, dalteparin sodium, per 2500 iu29$48.41
J1650Injection, enoxaparin sodium, 10 mg30$0.54
J1652Injection, fondaparinux sodium, 0.5 mg29$0.93
J1670Injection, tetanus immune globulin, human, up to 250 units30$594.01
J1700Injection, hydrocortisone acetate, up to 25 mg10$0.65
J1720Injection, hydrocortisone sodium succinate, up to 100 mg31$22.14
J1726Injection, hydroxyprogesterone caproate, (makena), 10 mg12$30.57
J1729Injection, hydroxyprogesterone caproate, not otherwise specified, 10 mg12$13.82
J1737Injection, meloxicam (azurity), 1 mg15$1.01
J1738Injection, meloxicam, 1 mg15$3.29
J1740Injection, ibandronate sodium, 1 mg31$45.15
J1741Injection, ibuprofen, 100 mg25$3.18
J1742Injection, ibutilide fumarate, 1 mg27$219.22
J1743Injection, idursulfase, 1 mg31$558.16
J1744Injection, icatibant, 1 mg24$125.32
J1745Injection, infliximab, excludes biosimilar, 10 mg32$31.48
J1746Injection, ibalizumab-uiyk, 10 mg31$77.54
J1747Injection, spesolimab-sbzo, 1 mg27$65.72
J1748Injection, infliximab-dyyb (zymfentra), 10 mg25$278.56
J1749Injection, iloprost, 0.1 mcg12$5.65
J1750Injection, iron dextran, 50 mg32$18.10
J1756Injection, iron sucrose, 1 mg31$0.23
J1786Injection, imiglucerase, 10 units31$43.32
J1790Injection, droperidol, up to 5 mg28$8.12
J1800Injection, propranolol hcl, up to 1 mg28$8.00
J1805Injection, esmolol hydrochloride, 10 mg24$0.23
J1806Injection, esmolol hydrochloride (wg critical care), not therapeutically equivalent to j1805, 10 mg25$0.35
J1807Injection, ethacrynate sodium, 1 mg18$28.10
J1808Injection, folic acid, 0.1 mg22$0.05
J1809Injection, fosdenopterin, 0.1 mg24$17.59
J1811Insulin (fiasp) for administration through dme (i.e., insulin pump) per 50 units20$7.85
J1812Insulin (fiasp), per 5 units17$0.58
J1813Insulin (lyumjev) for administration through dme (i.e., insulin pump) per 50 units20$13.60
J1814Insulin (lyumjev), per 5 units18$1.37
J1815Injection, insulin, per 5 units25$0.67
J1817Insulin for administration through dme (i.e., insulin pump) per 50 units20$3.06
J1823Injection, inebilizumab-cdon, 1 mg29$495.55
J1826Injection, interferon beta-1a, 30 mcg22$2,210.29
J1830Injection, interferon beta-1b, 0.25 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)23$438.99
J1833Injection, isavuconazonium, 1 mg28$1.02
J1834Injection, isoniazid, 1 mg17$0.32
J1835Injection, itraconazole, 50 mg11$42.28
J1836Injection, metronidazole, 10 mg25$0.03
J1837Injection, posaconazole, 1 mg23$0.34
J1885Injection, ketorolac tromethamine, per 15 mg30$0.30
J1920Injection, labetalol hydrochloride, 5 mg24$0.22
J1921Injection, labetalol hydrochloride (hikma), not therapeutically equivalent to j1920, 5 mg27$1.00
J1930Injection, lanreotide, 1 mg32$37.43
J1931Injection, laronidase, 0.1 mg30$39.95
J1932Injection, lanreotide, (cipla), 1 mg28$31.32
J1938Injection, furosemide, 1 mg25$0.02
J1939Injection, bumetanide, 0.5 mg26$0.50
J1941Injection, furosemide (furoscix), 20 mg20$245.15
J1943Injection, aripiprazole lauroxil, (aristada initio), 1 mg29$3.46
J1944Injection, aripiprazole lauroxil, (aristada), 1 mg30$3.54
J1950Injection, leuprolide acetate (for depot suspension), per 3.75 mg33$1,763.87
J1951Injection, leuprolide acetate for depot suspension (fensolvi), 0.25 mg29$140.71
J1952Leuprolide injectable, camcevi, 1 mg27$53.11
J1953Injection, levetiracetam, 10 mg29$0.03
J1954Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg23$687.29
J1955Injection, levocarnitine, per 1 gm28$22.61
J1956Injection, levofloxacin, 250 mg28$1.91
J1961Injection, lenacapavir (only for use as hiv treatment), 1 mg28$22.30
J1980Injection, hyoscyamine sulfate, up to 0.25 mg19$35.46

Published Medicaid fee-for-service schedule amounts, not a coverage or eligibility guarantee. Managed-care plan rates can differ. Where no prior-authorization flag is shown, the state does not publish one. Descriptions are ProviderSignal's own plain-language labels or public-domain CMS text.