| Code | Description | States | Median rate |
|---|---|---|---|
| J7030 | Infusion, normal saline solution , 1000 cc | 30 | $2.18 |
| J7040 | Infusion, normal saline solution, sterile (500 ml = 1 unit) | 28 | $1.35 |
| J7042 | 5% dextrose/normal saline (500 ml = 1 unit) | 28 | $1.22 |
| J7050 | Infusion, normal saline solution, 250 cc | 28 | $0.70 |
| J7060 | 5% dextrose/water (500 ml = 1 unit) | 29 | $1.71 |
| J7070 | Infusion, d5w, 1000 cc | 29 | $2.94 |
| J7100 | Infusion, dextran 40, 500 ml | 20 | $35.94 |
| J7110 | Infusion, dextran 75, 500 ml | 11 | $14.52 |
| J7120 | Ringers lactate infusion, up to 1000 cc | 28 | $2.31 |
| J7121 | 5% dextrose in lactated ringers infusion, up to 1000 cc | 16 | $4.76 |
| J7131 | Hypertonic saline solution, 1 ml | 12 | $0.10 |
| J7165 | Injection, prothrombin complex concentrate, human-lans, per i.u. of factor ix activity | 22 | $3.15 |
| J7168 | Prothrombin complex concentrate (human), kcentra, per i.u. of factor ix activity | 25 | $2.62 |
| J7169 | Injection, coagulation factor xa (recombinant), inactivated-zhzo (andexxa), 10 mg | 22 | $131.31 |
| J7170 | Injection, emicizumab-kxwh, 0.5 mg | 29 | $56.46 |
| J7171 | Injection, adamts13, recombinant-krhn, 10 iu | 27 | $35.53 |
| J7172 | Injection, marstacimab-hncq, 0.5 mg | 22 | $50.95 |
| J7173 | Injection, concizumab-mtci, 0.5 mg | 21 | $86.15 |
| J7174 | Injection, fitusiran, 0.04 mg | 22 | $131.20 |
| J7175 | Injection, factor x, (human), 1 i.u. | 27 | $9.92 |
| J7176 | Injection, human fibrinogen - chmt (fesilty), 1 mg | 11 | $1.10 |
| J7177 | Injection, human fibrinogen concentrate (fibryga), 1 mg | 27 | $1.23 |
| J7178 | Injection, human fibrinogen concentrate, not otherwise specified, 1 mg | 27 | $1.48 |
| J7179 | Injection, von willebrand factor (recombinant), (vonvendi), 1 i.u. vwf:rco | 26 | $1.81 |
| J7180 | Injection, factor xiii (antihemophilic factor, human), 1 i.u. | 27 | $10.76 |
| J7181 | Injection, factor xiii a-subunit, (recombinant), per iu | 29 | $18.56 |
| J7182 | Injection, factor viii, (antihemophilic factor, recombinant), (novoeight), per iu | 24 | $1.44 |
| J7183 | Injection, von willebrand factor complex (human), wilate, 1 i.u. vwf:rco | 28 | $1.32 |
| J7185 | Injection, factor viii (antihemophilic factor, recombinant) (xyntha), per i.u. | 28 | $1.38 |
| J7186 | Injection, antihemophilic factor viii/von willebrand factor complex (human), per factor viii i.u. | 28 | $1.24 |
| J7187 | Injection, von willebrand factor complex (humate-p), per iu vwf:rco | 28 | $1.49 |
| J7188 | Injection, factor viii (antihemophilic factor, recombinant), (obizur), per i.u. | 27 | $3.23 |
| J7189 | Factor viia (antihemophilic factor, recombinant), (novoseven rt), 1 microgram | 28 | $2.62 |
| J7190 | Factor viii (antihemophilic factor, human) per i.u. | 28 | $1.13 |
| J7191 | Factor viii (antihemophilic factor (porcine)), per i.u. | 12 | $2.63 |
| J7192 | Factor viii (antihemophilic factor, recombinant) per i.u., not otherwise specified | 28 | $1.58 |
| J7193 | Factor ix (antihemophilic factor, purified, non-recombinant) per i.u. | 26 | $1.37 |
| J7194 | Factor ix, complex, per i.u. | 24 | $1.70 |
| J7195 | Injection, factor ix (antihemophilic factor, recombinant) per iu, not otherwise specified | 27 | $1.83 |
| J7196 | Injection, antithrombin recombinant, 50 i.u. | 12 | $102.87 |
| J7197 | Antithrombin iii (human), per i.u. | 26 | $4.17 |
| J7198 | Anti-inhibitor, per i.u. | 25 | $2.39 |
| J7200 | Injection, factor ix, (antihemophilic factor, recombinant), rixubis, per iu | 27 | $1.72 |
| J7201 | Injection, factor ix, fc fusion protein, (recombinant), alprolix, 1 i.u. | 27 | $3.60 |
| J7202 | Injection, factor ix, albumin fusion protein, (recombinant), idelvion, 1 i.u. | 28 | $5.32 |
| J7203 | Injection factor ix, (antihemophilic factor, recombinant), glycopegylated, (rebinyn), 1 iu | 26 | $4.55 |
| J7204 | Injection, factor viii, antihemophilic factor (recombinant), (esperoct), glycopegylated-exei, per iu | 25 | $2.24 |
| J7205 | Injection, factor viii fc fusion protein (recombinant), per iu | 28 | $2.47 |
| J7207 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated, 1 i.u. | 27 | $2.11 |
| J7208 | Injection, factor viii, (antihemophilic factor, recombinant), pegylated-aucl, (jivi), 1 i.u. | 27 | $2.65 |
| J7209 | Injection, factor viii, (antihemophilic factor, recombinant), (nuwiq), 1 i.u. | 27 | $1.22 |
| J7210 | Injection, factor viii, (antihemophilic factor, recombinant), (afstyla), 1 i.u. | 27 | $1.58 |
| J7211 | Injection, factor viii, (antihemophilic factor, recombinant), (kovaltry), 1 i.u. | 27 | $1.57 |
| J7212 | Factor viia (antihemophilic factor, recombinant)-jncw (sevenfact), 1 microgram | 25 | $2.19 |
| J7213 | Injection, coagulation factor ix (recombinant), ixinity, 1 i.u. | 25 | $1.94 |
| J7214 | Injection, factor viii/von willebrand factor complex, recombinant (altuviiio), per factor viii i.u. | 25 | $4.63 |
| J7294 | Segesterone acetate and ethinyl estradiol 0.15mg, 0.013mg per 24 hours; yearly vaginal system, each | 27 | $2,326.05 |
| J7295 | Ethinyl estradiol and etonogestrel 0.015mg, 0.12mg per 24 hours; monthly vaginal ring, each | 25 | $122.72 |
| J7296 | Levonorgestrel-releasing intrauterine contraceptive system, (kyleena), 19.5 mg | 32 | $1,272.44 |
| J7297 | Levonorgestrel-releasing intrauterine contraceptive system (liletta), 52 mg | 32 | $978.32 |
| J7298 | Levonorgestrel-releasing intrauterine contraceptive system (mirena), 52 mg | 32 | $1,270.68 |
| J7300 | Intrauterine copper contraceptive (paragard) | 32 | $1,187.00 |
| J7301 | Levonorgestrel-releasing intrauterine contraceptive system (skyla), 13.5 mg | 32 | $1,059.52 |
| J7304 | Contraceptive supply, hormone containing patch, each | 19 | $40.72 |
| J7307 | Etonogestrel (contraceptive) implant system, including implant and supplies | 32 | $1,275.36 |
| J7308 | Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg) | 26 | $389.28 |
| J7311 | Injection, fluocinolone acetonide, intravitreal implant (retisert), 0.01 mg | 30 | $338.80 |
| J7312 | Injection, dexamethasone, intravitreal implant, 0.1 mg | 31 | $203.66 |
| J7313 | Injection, fluocinolone acetonide, intravitreal implant (iluvien), 0.01 mg | 32 | $507.44 |
| J7314 | Injection, fluocinolone acetonide, intravitreal implant (yutiq), 0.01 mg | 29 | $529.89 |
| J7315 | Mitomycin, ophthalmic, 0.2 mg | 10 | $430.00 |
| J7316 | Injection, ocriplasmin, 0.125 mg | 18 | $1,046.93 |
| J7318 | Hyaluronan or derivative, durolane, for intra-articular injection, 1 mg | 24 | $6.52 |
| J7320 | Hyaluronan or derivitive, genvisc 850, for intra-articular injection, 1 mg | 23 | $4.76 |
| J7321 | Hyaluronan or derivative, hyalgan, supartz or visco-3, for intra-articular injection, per dose | 29 | $72.95 |
| J7322 | Hyaluronan or derivative, hymovis or hymovis one, for intra-articular injection, 1 mg | 24 | $18.13 |
| J7323 | Hyaluronan or derivative, euflexxa, for intra-articular injection, per dose | 29 | $106.21 |
| J7324 | Hyaluronan or derivative, orthovisc, for intra-articular injection, per dose | 29 | $109.09 |
| J7325 | Hyaluronan or derivative, synvisc or synvisc-one, for intra-articular injection, 1 mg | 28 | $7.56 |
| J7326 | Hyaluronan or derivative, gel-one, for intra-articular injection, per dose | 25 | $528.05 |
| J7327 | Hyaluronan or derivative, monovisc, for intra-articular injection, per dose | 27 | $620.68 |
| J7328 | Hyaluronan or derivative, gelsyn-3, for intra-articular injection, 0.1 mg | 24 | $0.67 |
| J7329 | Hyaluronan or derivative, trivisc, for intra-articular injection, 1 mg | 20 | $3.61 |
| J7331 | Hyaluronan or derivative, synojoynt, for intra-articular injection, 1 mg | 16 | $3.12 |
| J7332 | Hyaluronan or derivative, triluron, for intra-articular injection, 1 mg | 21 | $10.43 |
| J7336 | Capsaicin 8% patch, per square centimeter | 26 | $3.42 |
| J7340 | Carbidopa 5 mg/levodopa 20 mg enteral suspension, 100 ml | 29 | $243.92 |
| J7342 | Instillation, ciprofloxacin otic suspension, 6 mg | 17 | $29.26 |
| J7345 | Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg | 18 | $1.79 |
| J7351 | Injection, bimatoprost, intracameral implant, 1 microgram | 31 | $213.76 |
| J7352 | Afamelanotide implant, 1 mg | 15 | $2,943.42 |
| J7353 | Anacaulase-bcdb, 8.8% gel, 1 gram | 11 | $57.27 |
| J7354 | Cantharidin for topical administration, 0.7%, single unit dose applicator (3.2 mg) | 27 | $695.20 |
| J7355 | Injection, travoprost, intracameral implant, 1 microgram | 27 | $196.74 |
| J7356 | Injection, foscarbidopa 0.25 mg/foslevodopa 5 mg | 20 | $0.70 |
| J7402 | Mometasone furoate sinus implant, (sinuva), 10 micrograms | 26 | $11.35 |
| J7500 | Azathioprine, oral, 50 mg | 19 | $0.14 |
| J7501 | Azathioprine, parenteral, 100 mg | 29 | $246.00 |
| J7502 | Cyclosporine, oral, 100 mg | 22 | $1.81 |
| J7503 | Tacrolimus, extended release, (envarsus xr), oral, 0.25 mg | 18 | $1.86 |
| J7504 | Lymphocyte immune globulin, antithymocyte globulin, equine, parenteral, 250 mg | 29 | $5,307.93 |
| J7507 | Tacrolimus, immediate release, oral, 1 mg | 23 | $0.20 |
| J7508 | Tacrolimus, extended release, (astagraf xl), oral, 0.1 mg | 23 | $0.60 |
| J7509 | Methylprednisolone oral, per 4 mg | 20 | $0.16 |
| J7510 | Prednisolone oral, per 5 mg | 20 | $0.78 |
| J7511 | Lymphocyte immune globulin, antithymocyte globulin, rabbit, parenteral, 25 mg | 29 | $1,033.81 |
| J7512 | Prednisone, immediate release or delayed release, oral, 1 mg | 17 | $0.01 |
| J7514 | Mycophenolate mofetil (myhibbin), oral suspension, 100 mg | 15 | $2.24 |
| J7515 | Cyclosporine, oral, 25 mg | 20 | $0.55 |
| J7516 | Injection, cyclosporine, 250 mg | 27 | $73.68 |
| J7517 | Mycophenolate mofetil, oral, 250 mg | 22 | $0.15 |
| J7518 | Mycophenolic acid, oral, 180 mg | 21 | $0.32 |
| J7519 | Injection, mycophenolate mofetil, 10 mg | 26 | $0.40 |
| J7520 | Sirolimus, oral, 1 mg | 22 | $0.97 |
| J7521 | Tacrolimus, granules, oral suspension, 0.1 mg | 17 | $1.30 |
| J7525 | Tacrolimus, parenteral, 5 mg | 28 | $262.45 |
| J7527 | Everolimus, oral, 0.25 mg | 20 | $1.18 |
| J7528 | Mycophenolate mofetil, for suspension, oral, 100 mg | 16 | $0.24 |
| J7601 | Ensifentrine, inhalation suspension, fda approved final product, non-compounded, administered through dme, unit dose form, 3 mg | 18 | $52.11 |
| J7605 | Arformoterol, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 15 micrograms | 22 | $0.74 |
| J7606 | Formoterol fumarate, inhalation solution, fda approved final product, non-compounded, administered through dme, unit dose form, 20 micrograms | 21 | $1.90 |
| J7608 | Acetylcysteine, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per gram | 24 | $7.27 |
| J7611 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 1 mg | 23 | $0.23 |
| J7612 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, concentrated form, 0.5 mg | 21 | $0.34 |
| J7613 | Albuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 1 mg | 24 | $0.07 |
| J7614 | Levalbuterol, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose, 0.5 mg | 21 | $0.08 |
| J7620 | Albuterol, up to 2.5 mg and ipratropium bromide, up to 0.5 mg, fda-approved final product, non-compounded, administered through dme | 24 | $0.20 |
| J7626 | Budesonide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, up to 0.5 mg | 22 | $1.09 |
| J7627 | Budesonide, inhalation solution, compounded product, administered through dme, unit dose form, up to 0.5 mg | 11 | $2.85 |
| J7631 | Cromolyn sodium, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per 10 milligrams | 20 | $0.69 |
| J7639 | Dornase alfa, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | 23 | $55.17 |
| J7644 | Ipratropium bromide, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, per milligram | 21 | $0.44 |
| J7665 | Mannitol, administered through an inhaler, 5 mg | 11 | $0.71 |
| J7674 | Methacholine chloride administered as inhalation solution through a nebulizer, per 1 mg | 18 | $1.90 |
| J7677 | Revefenacin inhalation solution, fda-approved final product, non-compounded, administered through dme, 1 microgram | 18 | $0.20 |
| J7682 | Tobramycin, inhalation solution, fda-approved final product, non-compounded, unit dose form, administered through dme, per 300 milligrams | 22 | $12.31 |
| J7686 | Treprostinil, inhalation solution, fda-approved final product, non-compounded, administered through dme, unit dose form, 1.74 mg | 23 | $832.82 |
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.