| Code | Description | States | Median rate |
|---|---|---|---|
| J2002 | Injection, lidocaine hcl in 5% dextrose, 1 mg | 14 | $0.01 |
| J2003 | Injection, lidocaine hydrochloride, 1 mg | 15 | $0.01 |
| J2004 | Injection, lidocaine hcl with epinephrine, 1 mg | 15 | $0.01 |
| J2010 | Injection, lincomycin hcl, up to 300 mg | 31 | $4.23 |
| J2020 | Injection, linezolid, 200 mg | 29 | $2.48 |
| J2021 | Injection, linezolid (hospira), not therapeutically equivalent to j2020, 200 mg | 27 | $26.11 |
| J2060 | Injection, lorazepam, 2 mg | 30 | $2.30 |
| J2062 | Loxapine for inhalation, 1 mg | 16 | $15.00 |
| J2151 | Injection, mannitol, 250 mg | 23 | $0.07 |
| J2170 | Injection, mecasermin, 1 mg | 13 | $258.28 |
| J2175 | Injection, meperidine hydrochloride, per 100 mg | 32 | $6.34 |
| J2182 | Injection, mepolizumab, 1 mg | 30 | $31.89 |
| J2183 | Injection, meropenem (wg critical care), not therapeutically equivalent to j2185, 100 mg | 26 | $1.48 |
| J2184 | Injection, meropenem (b. braun), not therapeutically equivalent to j2185, 100 mg | 28 | $1.95 |
| J2185 | Injection, meropenem, 100 mg | 27 | $0.35 |
| J2186 | Injection, meropenem and vaborbactam, 10mg/10mg (20mg) | 20 | $2.16 |
| J2210 | Injection, methylergonovine maleate, up to 0.2 mg | 29 | $21.55 |
| J2212 | Injection, methylnaltrexone, 0.1 mg | 17 | $1.42 |
| J2246 | Injection, micafungin in sodium (baxter), not therapeutically equivalent to j2248, 1 mg | 24 | $0.45 |
| J2247 | Injection, micafungin sodium (par pharm) not thereapeutically equivalent to j2248, 1 mg | 27 | $0.22 |
| J2248 | Injection, micafungin sodium, 1 mg | 30 | $0.25 |
| J2249 | Injection, remimazolam, 1 mg | 18 | $2.19 |
| J2250 | Injection, midazolam hydrochloride, per 1 mg | 27 | $0.14 |
| J2251 | Injection, midazolam in 0.9% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg | 25 | $0.16 |
| J2252 | Injection, midazolam in 0.8% sodium chloride, intravenous, not therapeutically equivalent to j2250, 1 mg | 16 | $0.08 |
| J2260 | Injection, milrinone lactate, 5 mg | 28 | $1.16 |
| J2265 | Injection, minocycline hydrochloride, 1 mg | 19 | $2.59 |
| J2267 | Injection, mirikizumab-mrkz, 1 mg | 31 | $36.21 |
| J2270 | Injection, morphine sulfate, up to 10 mg | 30 | $4.63 |
| J2272 | Injection, morphine sulfate (fresenius kabi), not therapeutically equivalent to j2270, up to 10 mg | 29 | $8.34 |
| J2274 | Injection, morphine sulfate, preservative-free for epidural or intrathecal use, 10 mg | 27 | $13.50 |
| J2277 | Injection, motixafortide, 0.25 mg | 28 | $26.48 |
| J2278 | Injection, ziconotide, 1 microgram | 25 | $10.57 |
| J2280 | Injection, moxifloxacin, 100 mg | 26 | $8.74 |
| J2281 | Injection, moxifloxacin (fresenius kabi), not therapeutically equivalent to j2280, 100 mg | 27 | $6.64 |
| J2290 | Injection, nafcillin sodium, 20 mg | 25 | $0.05 |
| J2291 | Injection, nafcillin sodium (baxter), 20 mg | 23 | $0.15 |
| J2300 | Injection, nalbuphine hydrochloride, per 10 mg | 30 | $4.19 |
| J2305 | Injection, nitroglycerin, 5 mg | 24 | $1.56 |
| J2312 | Injection, naloxone hydrochloride, not otherwise specified, 0.01 mg | 22 | $0.07 |
| J2313 | Injection, naloxone hydrochloride (zimhi), 0.01 mg | 19 | $0.02 |
| J2315 | Injection, naltrexone, depot form, 1 mg | 32 | $4.40 |
| J2320 | Injection, nandrolone decanoate, up to 50 mg | 11 | $3.86 |
| J2323 | Injection, natalizumab, 1 mg | 32 | $24.41 |
| J2325 | Injection, nesiritide, 0.1 mg | 18 | $60.25 |
| J2326 | Injection, nusinersen, 0.1 mg | 21 | $1,259.78 |
| J2327 | Injection, risankizumab-rzaa, intravenous, 1 mg | 32 | $14.57 |
| J2329 | Injection, ublituximab-xiiy, 1mg | 32 | $71.49 |
| J2350 | Injection, ocrelizumab, 1 mg | 31 | $59.68 |
| J2351 | Injection, ocrelizumab, 1 mg and hyaluronidase-ocsq | 26 | $47.05 |
| J2353 | Injection, octreotide, depot form for intramuscular injection, 1 mg | 33 | $207.77 |
| J2354 | Injection, octreotide, non-depot form for subcutaneous or intravenous injection, 25 mcg | 28 | $0.62 |
| J2355 | Injection, oprelvekin, 5 mg | 17 | $403.67 |
| J2356 | Injection, tezepelumab-ekko, 1 mg | 29 | $17.92 |
| J2357 | Injection, omalizumab, 5 mg | 31 | $45.50 |
| J2358 | Injection, olanzapine, long-acting, 1 mg | 30 | $3.19 |
| J2359 | Injection, olanzapine, 0.5 mg | 25 | $0.71 |
| J2360 | Injection, orphenadrine citrate, up to 60 mg | 28 | $7.78 |
| J2361 | Injection, depemokimab-ulaa, 1 mg | 16 | $260.00 |
| J2371 | Injection, phenylephrine hydrochloride, 20 micrograms | 12 | $0.01 |
| J2372 | Injection, phenylephrine hydrochloride (biorphen), 20 micrograms | 21 | $0.16 |
| J2373 | Injection, phenylephrine hydrochloride (immphentiv), 20 micrograms | 22 | $0.13 |
| J2374 | Apraclonidine hydrochloride ophthalmic, 1% solution, 0.1 ml | 10 | $50.87 |
| J2401 | Injection, chloroprocaine hydrochloride, per 1 mg | 23 | $0.04 |
| J2402 | Injection, chloroprocaine hydrochloride (clorotekal), per 1 mg | 14 | $0.31 |
| J2403 | Chloroprocaine hcl ophthalmic, 3% gel, 1 mg | 20 | $0.61 |
| J2404 | Injection, nicardipine, 0.1 mg | 23 | $0.07 |
| J2405 | Injection, ondansetron hydrochloride, per 1 mg | 31 | $0.09 |
| J2406 | Injection, oritavancin (kimyrsa), 10 mg | 31 | $43.72 |
| J2407 | Injection, oritavancin (orbactiv), 10 mg | 33 | $28.68 |
| J2410 | Injection, oxymorphone hcl, up to 1 mg | 15 | $2.85 |
| J2425 | Injection, palifermin, 50 micrograms | 30 | $36.63 |
| J2426 | Injection, paliperidone palmitate extended release (invega sustenna), 1 mg | 32 | $15.11 |
| J2427 | Injection, paliperidone palmitate extended release (invega hafyera, or invega trinza), 1 mg | 29 | $13.00 |
| J2428 | Injection, paliperidone palmitate extended release (erzofri), 1 mg | 22 | $15.87 |
| J2430 | Injection, pamidronate disodium, per 30 mg | 32 | $12.03 |
| J2440 | Injection, papaverine hcl, up to 60 mg | 24 | $31.30 |
| J2460 | Injection, oxytetracycline hcl, up to 50 mg | 11 | $0.95 |
| J2468 | Injection, palonosetron hydrochloride (posfrea), 25 micrograms | 27 | $55.29 |
| J2469 | Injection, palonosetron hcl, 25 mcg | 31 | $0.57 |
| J2470 | Injection, pantoprazole sodium, 40 mg | 18 | $3.46 |
| J2471 | Injection, pantoprazole (hikma), not therapeutically equivalent to j2470, 40 mg | 18 | $3.50 |
| J2472 | Injection, pantoprazole sodium in sodium chloride (baxter), 40 mg | 17 | $7.98 |
| J2501 | Injection, paricalcitol, 1 mcg | 30 | $0.90 |
| J2502 | Injection, pasireotide long acting, 1 mg | 31 | $574.02 |
| J2506 | Injection, pegfilgrastim, excludes biosimilar, 0.5 mg | 32 | $143.23 |
| J2507 | Injection, pegloticase, 1 mg | 32 | $3,768.81 |
| J2508 | Injection, pegunigalsidase alfa-iwxj, 1 mg | 29 | $225.77 |
| J2510 | Injection, penicillin g procaine, aqueous, up to 600,000 units | 23 | $43.38 |
| J2515 | Injection, pentobarbital sodium, per 50 mg | 28 | $31.62 |
| J2516 | Injection, pentamidine isethionate, 1 mg | 22 | $0.16 |
| J2540 | Injection, penicillin g potassium, up to 600,000 units | 30 | $0.64 |
| J2543 | Injection, piperacillin sodium/tazobactam sodium, 1 gram/0.125 grams (1.125 grams) | 29 | $1.22 |
| J2545 | Pentamidine isethionate, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 300 mg | 28 | $73.00 |
| J2547 | Injection, peramivir, 1 mg | 26 | $1.58 |
| J2550 | Injection, promethazine hcl, up to 50 mg | 31 | $3.64 |
| J2560 | Injection, phenobarbital sodium, up to 120 mg | 30 | $24.77 |
| J2561 | Injection, phenobarbital sodium (sezaby), 1 mg | 23 | $1.33 |
| J2562 | Injection, plerixafor, 1 mg | 31 | $30.66 |
| J2590 | Injection, oxytocin, up to 10 units | 25 | $0.91 |
| J2596 | Injection, vasopressin (long grove), not therapeutically equivalent to j2598, 1 unit | 22 | $1.18 |
| J2597 | Injection, desmopressin acetate, per 1 mcg | 29 | $3.56 |
| J2598 | Injection, vasopressin, 1 unit | 25 | $0.53 |
| J2599 | Injection, vasopressin (american regent), not therapeutically equivalent to j2598, 1 unit | 24 | $0.83 |
| J2601 | Injection, vasopressin (baxter), 1 unit | 23 | $2.22 |
| J2650 | Injection, prednisolone acetate, up to 1 ml | 11 | $0.52 |
| J2675 | Injection, progesterone, per 50 mg | 27 | $0.63 |
| J2679 | Injection, fluphenazine hcl, 1.25 mg | 28 | $7.33 |
| J2680 | Injection, fluphenazine decanoate, up to 25 mg | 30 | $5.78 |
| J2690 | Injection, procainamide hcl, up to 1 gm | 31 | $295.36 |
| J2700 | Injection, oxacillin sodium, up to 250 mg | 30 | $0.76 |
| J2704 | Injection, propofol, 10 mg | 22 | $0.09 |
| J2710 | Injection, neostigmine methylsulfate, up to 0.5 mg | 25 | $0.40 |
| J2711 | Injection, neostigmine methylsulfate 0.1 mg and glycopyrrolate 0.02 mg | 15 | $0.71 |
| J2720 | Injection, protamine sulfate, per 10 mg | 30 | $1.76 |
| J2724 | Injection, protein c concentrate, intravenous, human, 10 iu | 31 | $15.07 |
| J2725 | Injection, protirelin, per 250 mcg | 10 | $22.78 |
| J2730 | Injection, pralidoxime chloride, up to 1 gm | 24 | $87.70 |
| J2760 | Injection, phentolamine mesylate, up to 5 mg | 29 | $288.63 |
| J2765 | Injection, metoclopramide hcl, up to 10 mg | 31 | $1.00 |
| J2770 | Injection, quinupristin/dalfopristin, 500 mg (150/350) | 17 | $462.28 |
| J2777 | Injection, faricimab-svoa, 0.1 mg | 30 | $32.87 |
| J2778 | Injection, ranibizumab, 0.1 mg | 31 | $65.73 |
| J2779 | Injection, ranibizumab, via intravitreal implant (susvimo), 0.1 mg | 27 | $76.22 |
| J2781 | Injection, pegcetacoplan, intravitreal, 1 mg | 30 | $148.41 |
| J2782 | Injection, avacincaptad pegol, 0.1 mg | 29 | $103.20 |
| J2783 | Injection, rasburicase, 0.5 mg | 27 | $382.78 |
| J2785 | Injection, regadenoson, 0.1 mg | 31 | $2.79 |
| J2786 | Injection, reslizumab, 1 mg | 31 | $11.38 |
| J2787 | Riboflavin 5'-phosphate, ophthalmic solution (photrexa viscous/photrexa), up to 3 ml | 16 | $2,280.00 |
| J2788 | Injection, rho d immune globulin, human, minidose, 50 micrograms (250 i.u.) | 31 | $25.54 |
| J2789 | Riboflavin 5'-phosphate, ophthalmic solution (epioxahd/epioxa), up to 2 ml | 13 | $58,835.75 |
| J2790 | Injection, rho d immune globulin, human, full dose, 300 micrograms (1500 i.u.) | 32 | $85.13 |
| J2791 | Injection, rho(d) immune globulin (human), (rhophylac), intramuscular or intravenous, 100 iu | 32 | $4.88 |
| J2792 | Injection, rho d immune globulin, intravenous, human, solvent detergent, 100 iu | 33 | $34.26 |
| J2793 | Injection, rilonacept, 1 mg | 18 | $28.59 |
| J2794 | Injection, risperidone (risperdal consta), 0.5 mg | 31 | $11.11 |
| J2795 | Injection, ropivacaine hydrochloride, 1 mg | 22 | $0.05 |
| J2797 | Injection, rolapitant, 0.5 mg | 12 | $0.94 |
| J2798 | Injection, risperidone, (perseris), 0.5 mg | 28 | $12.19 |
| J2799 | Injection, risperidone (uzedy), 1 mg | 29 | $26.18 |
| J2800 | Injection, methocarbamol, up to 10 ml | 29 | $4.51 |
| J2801 | Injection, risperidone (rykindo), 0.5 mg | 20 | $12.91 |
| J2802 | Injection, romiplostim, 1 microgram | 30 | $11.26 |
| J2804 | Injection, rifampin, 1 mg | 22 | $0.17 |
| J2805 | Injection, sincalide, 5 micrograms | 21 | $110.46 |
| J2820 | Injection, sargramostim (gm-csf), 50 mcg | 32 | $62.47 |
| J2840 | Injection, sebelipase alfa, 1 mg | 27 | $511.52 |
| J2850 | Injection, secretin, synthetic, human, 1 microgram | 22 | $35.83 |
| J2860 | Injection, siltuximab, 10 mg | 31 | $168.68 |
| J2865 | Injection, sulfamethoxazole 5 mg and trimethoprim 1 mg | 22 | $0.04 |
| J2916 | Injection, sodium ferric gluconate complex in sucrose injection, 12.5 mg | 30 | $2.20 |
| J2919 | Injection, methylprednisolone sodium succinate, 5 mg | 29 | $0.22 |
| J2941 | Injection, somatropin, 1 mg | 23 | $55.08 |
| J2993 | Injection, reteplase, 18.1 mg | 18 | $2,819.31 |
| J2997 | Injection, alteplase recombinant, 1 mg | 32 | $94.14 |
| J2998 | Injection, plasminogen, human-tvmh, 1 mg | 24 | $34.43 |
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.