| Code | Description | States | Median rate |
|---|---|---|---|
| J3000 | Injection, streptomycin, up to 1 gm | 28 | $26.88 |
| J3010 | Injection, fentanyl citrate, 0.1 mg | 29 | $1.38 |
| J3030 | Injection, sumatriptan succinate, 6 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) | 27 | $50.00 |
| J3031 | Injection, fremanezumab-vfrm, 1 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) | 22 | $3.35 |
| J3032 | Injection, eptinezumab-jjmr, 1 mg | 31 | $20.50 |
| J3055 | Injection, talquetamab-tgvs, 0.25 mg | 29 | $74.92 |
| J3060 | Injection, taliglucerase alfa, 10 units | 31 | $41.62 |
| J3070 | Injection, pentazocine, 30 mg | 17 | $108.39 |
| J3090 | Injection, tedizolid phosphate, 1 mg | 32 | $1.96 |
| J3095 | Injection, telavancin, 10 mg | 32 | $7.40 |
| J3101 | Injection, tenecteplase, 1 mg | 30 | $186.97 |
| J3105 | Injection, terbutaline sulfate, up to 1 mg | 30 | $2.82 |
| J3110 | Injection, teriparatide, 10 mcg | 17 | $24.10 |
| J3111 | Injection, romosozumab-aqqg, 1 mg | 32 | $12.19 |
| J3121 | Injection, testosterone enanthate, 1 mg | 27 | $0.05 |
| J3145 | Injection, testosterone undecanoate, 1 mg | 31 | $2.13 |
| J3230 | Injection, chlorpromazine hcl, up to 50 mg | 30 | $18.14 |
| J3240 | Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial | 32 | $2,125.64 |
| J3241 | Injection, teprotumumab-trbw, 10 mg | 32 | $369.31 |
| J3243 | Injection, tigecycline, 1 mg | 29 | $0.55 |
| J3244 | Injection, tigecycline (accord), not therapeutically equivalent to j3243, 1 mg | 22 | $2.50 |
| J3245 | Injection, tildrakizumab, 1 mg | 28 | $124.27 |
| J3246 | Injection, tirofiban hcl, 0.25 mg | 22 | $2.96 |
| J3247 | Injection, secukinumab, intravenous, 1 mg | 30 | $18.07 |
| J3250 | Injection, trimethobenzamide hcl, up to 200 mg | 30 | $62.93 |
| J3260 | Injection, tobramycin sulfate, up to 80 mg | 31 | $2.19 |
| J3262 | Injection, tocilizumab, 1 mg | 32 | $5.41 |
| J3263 | Injection, toripalimab-tpzi, 1 mg | 29 | $40.21 |
| J3265 | Injection, torsemide, 10 mg/ml | 10 | $2.24 |
| J3285 | Injection, treprostinil, 1 mg | 31 | $54.74 |
| J3290 | Injection, tranexamic acid, 5 mg | 15 | $0.03 |
| J3291 | Injection, tranexamic acid in sodium chloride, 5 mg | 15 | $0.10 |
| J3299 | Injection, triamcinolone acetonide (xipere), 1 mg | 29 | $47.77 |
| J3300 | Injection, triamcinolone acetonide, preservative free, 1 mg | 31 | $19.19 |
| J3301 | Injection, triamcinolone acetonide, not otherwise specified, 10 mg | 31 | $1.00 |
| J3303 | Injection, triamcinolone hexacetonide, per 5 mg | 18 | $3.83 |
| J3304 | Injection, triamcinolone acetonide, preservative-free, extended-release, microsphere formulation, 1 mg | 32 | $19.28 |
| J3315 | Injection, triptorelin pamoate, 3.75 mg | 31 | $466.37 |
| J3316 | Injection, triptorelin, extended-release, 3.75 mg | 31 | $3,764.99 |
| J3357 | Ustekinumab, for subcutaneous injection, 1 mg | 30 | $155.88 |
| J3358 | Ustekinumab, for intravenous injection, 1 mg | 32 | $11.62 |
| J3360 | Injection, diazepam, up to 5 mg | 30 | $6.85 |
| J3373 | Injection, vancomycin hydrochloride, 10 mg | 25 | $0.03 |
| J3374 | Injection, vancomycin hydrochloride (mylan) not therapeutically equivalent to j3373, 10 mg | 24 | $0.10 |
| J3375 | Injection, vancomycin hydrochloride (tyzavan), not therapeutically equivalent to j3373, 10 mg | 24 | $0.14 |
| J3376 | Injection, vancomycin hcl (hikma), not therapeutically equivalent to j3373, 10 mg | 23 | $0.02 |
| J3379 | Injection, valproate sodium, 5 mg | 21 | $0.04 |
| J3380 | Injection, vedolizumab, intravenous, 1 mg | 32 | $21.62 |
| J3385 | Injection, velaglucerase alfa, 100 units | 31 | $386.43 |
| J3396 | Injection, verteporfin, 0.1 mg | 31 | $11.37 |
| J3397 | Injection, vestronidase alfa-vjbk, 1 mg | 21 | $282.50 |
| J3398 | Injection, voretigene neparvovec-rzyl, 1 billion vector genomes | 19 | $3,059.60 |
| J3399 | Injection, onasemnogene abeparvovec-xioi, per treatment, up to 5x10^15 vector genomes | 10 | $2,391,705.69 |
| J3401 | Beremagene geperpavec-svdt for topical administration, containing nominal 5 x 10^9 pfu/ml vector genomes, per 0.1 ml | 26 | $1,021.11 |
| J3402 | Injection, remestemcel-l-rknd, per therapeutic dose | 19 | $203,659.76 |
| J3403 | Revakinagene taroretcel-lwey, per implant | 18 | $262,233.77 |
| J3404 | Injection, zopapogene imadenovec-drba suspension, per therapeutic dose | 13 | $115,000.00 |
| J3410 | Injection, hydroxyzine hcl, up to 25 mg | 29 | $15.21 |
| J3411 | Injection, thiamine hcl, 100 mg | 24 | $1.67 |
| J3415 | Injection, pyridoxine hcl, 100 mg | 23 | $12.94 |
| J3420 | Injection, vitamin b-12 cyanocobalamin, up to 1000 mcg | 29 | $0.68 |
| J3424 | Injection, hydroxocobalamin, intravenous, 25 mg | 15 | $5.37 |
| J3425 | Injection, hydroxocobalamin, intramuscular, 10 mcg | 22 | $0.01 |
| J3430 | Injection, phytonadione (vitamin k), per 1 mg | 30 | $3.25 |
| J3465 | Injection, voriconazole, 10 mg | 26 | $0.75 |
| J3470 | Injection, hyaluronidase, up to 150 units | 24 | $31.76 |
| J3471 | Injection, hyaluronidase, ovine, preservative free, per 1 usp unit (up to 999 usp units) | 19 | $0.50 |
| J3472 | Injection, hyaluronidase, ovine, preservative free, per 1000 usp units | 17 | $142.19 |
| J3473 | Injection, hyaluronidase, recombinant, 1 usp unit | 25 | $0.36 |
| J3475 | Injection, magnesium sulfate, per 500 mg | 29 | $0.45 |
| J3480 | Injection, potassium chloride, per 2 meq | 28 | $0.13 |
| J3485 | Injection, zidovudine, 10 mg | 26 | $1.51 |
| J3486 | Injection, ziprasidone mesylate, 10 mg | 26 | $6.18 |
| J3489 | Injection, zoledronic acid, 1 mg | 32 | $4.81 |
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.