| Code | Description | States | Median rate |
|---|---|---|---|
| J9000 | Injection, doxorubicin hydrochloride, 10 mg | 32 | $2.71 |
| J9011 | Injection, datopotamab deruxtecan-dlnk, 1 mg | 28 | $51.56 |
| J9015 | Injection, aldesleukin, per single use vial | 22 | $3,338.87 |
| J9017 | Injection, arsenic trioxide, 1 mg | 32 | $5.16 |
| J9021 | Injection, asparaginase, recombinant, (rylaze), 0.1 mg | 31 | $56.18 |
| J9022 | Injection, atezolizumab, 10 mg | 33 | $93.91 |
| J9023 | Injection, avelumab, 10 mg | 33 | $105.55 |
| J9024 | Injection, atezolizumab, 5 mg and hyaluronidase-tqjs | 25 | $32.10 |
| J9025 | Injection, azacitidine, 1 mg | 30 | $0.40 |
| J9026 | Injection, tarlatamab-dlle, 1 mg | 30 | $1,567.72 |
| J9027 | Injection, clofarabine, 1 mg | 31 | $16.25 |
| J9028 | Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram | 28 | $94.31 |
| J9029 | Intravesical instillation, nadofaragene firadenovec-vncg, per therapeutic dose | 25 | $64,274.79 |
| J9030 | Bcg live intravesical instillation, 1 mg | 32 | $3.37 |
| J9032 | Injection, belinostat, 10 mg | 33 | $53.11 |
| J9033 | Injection, bendamustine hydrochloride, 1 mg | 32 | $2.96 |
| J9034 | Injection, bendamustine hcl (bendeka), 1 mg | 33 | $12.83 |
| J9035 | Injection, bevacizumab, 10 mg | 33 | $74.36 |
| J9036 | Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg | 29 | $12.93 |
| J9038 | Injection, axatilimab-csfr, 0.1 mg | 24 | $55.65 |
| J9039 | Injection, blinatumomab, 1 microgram | 33 | $163.68 |
| J9040 | Injection, bleomycin sulfate, 15 units | 32 | $24.84 |
| J9041 | Injection, bortezomib, 0.1 mg | 32 | $2.19 |
| J9042 | Injection, brentuximab vedotin, 1 mg | 32 | $268.45 |
| J9043 | Injection, cabazitaxel, 1 mg | 31 | $230.80 |
| J9045 | Injection, carboplatin, 50 mg | 31 | $3.15 |
| J9046 | Injection, bortezomib (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg | 25 | $45.34 |
| J9047 | Injection, carfilzomib, 1 mg | 32 | $55.61 |
| J9048 | Injection, bortezomib (fresenius kabi), not therapeutically equivalent to j9041, 0.1 mg | 26 | $5.03 |
| J9049 | Injection, bortezomib (hospira), not therapeutically equivalent to j9041, 0.1 mg | 28 | $1.71 |
| J9050 | Injection, carmustine, 100 mg | 33 | $240.01 |
| J9052 | Injection, carmustine (accord), not therapeutically equivalent to j9050, 100 mg | 28 | $18.40 |
| J9053 | Injection, belantamab mafodotin-blmf, 0.1 mg | 18 | $36.25 |
| J9054 | Injection, bortezomib (boruzu), 0.1 mg | 26 | $24.90 |
| J9055 | Injection, cetuximab, 10 mg | 33 | $80.40 |
| J9056 | Injection, bendamustine hydrochloride (vivimusta), 1 mg | 30 | $29.91 |
| J9057 | Injection, copanlisib, 1 mg | 22 | $87.56 |
| J9060 | Injection, cisplatin, powder or solution, 10 mg | 31 | $2.13 |
| J9061 | Injection, amivantamab-vmjw, 2 mg | 31 | $22.56 |
| J9062 | Injection, amivantamab 5 mg and hyaluronidase-lpuj | 17 | $40.74 |
| J9063 | Injection, mirvetuximab soravtansine-gynx, 1 mg | 31 | $71.17 |
| J9065 | Injection, cladribine, per 1 mg | 33 | $8.19 |
| J9071 | Injection, cyclophosphamide (auromedics), 5 mg | 29 | $0.61 |
| J9072 | Injection, cyclophosphamide (frindovyx), 5 mg | 31 | $8.92 |
| J9073 | Injection, cyclophosphamide (dr. reddy's), 5 mg | 29 | $0.55 |
| J9074 | Injection, cyclophosphamide (sandoz), 5 mg | 30 | $3.74 |
| J9075 | Injection, cyclophosphamide, not otherwise specified, 5 mg | 29 | $0.59 |
| J9076 | Injection, cyclophosphamide (baxter), 5 mg | 27 | $4.39 |
| J9100 | Injection, cytarabine, 100 mg | 30 | $0.85 |
| J9118 | Injection, calaspargase pegol-mknl, 10 units | 30 | $82.08 |
| J9119 | Injection, cemiplimab-rwlc, 1 mg | 32 | $29.39 |
| J9120 | Injection, dactinomycin, 0.5 mg | 33 | $307.99 |
| J9130 | Dacarbazine, 100 mg | 31 | $3.56 |
| J9144 | Injection, daratumumab, 10 mg and hyaluronidase-fihj | 32 | $55.06 |
| J9145 | Injection, daratumumab, 10 mg | 33 | $70.79 |
| J9150 | Injection, daunorubicin, 10 mg | 32 | $28.81 |
| J9153 | Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine | 32 | $260.49 |
| J9155 | Injection, degarelix, 1 mg | 32 | $4.46 |
| J9161 | Injection, denileukin diftitox-cxdl, 1 mcg | 11 | $12.82 |
| J9171 | Injection, docetaxel, 1 mg | 30 | $0.56 |
| J9172 | Injection, docetaxel (docivyx), 1 mg | 29 | $47.27 |
| J9173 | Injection, durvalumab, 10 mg | 33 | $86.27 |
| J9174 | Injection, docetaxel (beizray), 1 mg | 13 | $46.80 |
| J9175 | Injection, elliotts' b solution, 1 ml | 14 | $4.29 |
| J9176 | Injection, elotuzumab, 1 mg | 33 | $8.04 |
| J9177 | Injection, enfortumab vedotin-ejfv, 0.25 mg | 32 | $36.66 |
| J9178 | Injection, epirubicin hcl, 2 mg | 32 | $1.99 |
| J9179 | Injection, eribulin mesylate, 0.1 mg | 32 | $76.76 |
| J9181 | Injection, etoposide, 10 mg | 32 | $1.02 |
| J9183 | Gemcitabine intravesical system, 225 mg | 19 | $72,984.24 |
| J9184 | Injection, gemcitabine hydrochloride (avyxa), 200 mg | 22 | $400.33 |
| J9185 | Injection, fludarabine phosphate, 50 mg | 32 | $206.30 |
| J9190 | Injection, fluorouracil, 500 mg | 32 | $2.02 |
| J9196 | Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg | 28 | $5.29 |
| J9198 | Injection, gemcitabine hydrochloride, (infugem), 100 mg | 20 | $39.90 |
| J9200 | Injection, floxuridine, 500 mg | 32 | $4,254.92 |
| J9201 | Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg | 32 | $2.98 |
| J9202 | Goserelin acetate implant, per 3.6 mg | 18 | $777.50 |
| J9203 | Injection, gemtuzumab ozogamicin, 0.1 mg | 30 | $240.17 |
| J9204 | Injection, mogamulizumab-kpkc, 1 mg | 32 | $253.47 |
| J9205 | Injection, irinotecan liposome, 1 mg | 33 | $65.86 |
| J9206 | Injection, irinotecan, 20 mg | 32 | $1.85 |
| J9207 | Injection, ixabepilone, 1 mg | 32 | $139.75 |
| J9208 | Injection, ifosfamide, 1 gram | 32 | $27.61 |
| J9209 | Injection, mesna, 200 mg | 32 | $1.41 |
| J9210 | Injection, emapalumab-lzsg, 1 mg | 29 | $384.13 |
| J9211 | Injection, idarubicin hydrochloride, 5 mg | 31 | $38.13 |
| J9213 | Injection, interferon, alfa-2a, recombinant, 3 million units | 12 | $40.53 |
| J9214 | Injection, interferon, alfa-2b, recombinant, 1 million units | 21 | $32.42 |
| J9215 | Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu | 15 | $15.68 |
| J9216 | Injection, interferon, gamma 1-b, 3 million units | 24 | $8,056.37 |
| J9217 | Leuprolide acetate (for depot suspension), 7.5 mg | 33 | $170.78 |
| J9218 | Leuprolide acetate, per 1 mg | 28 | $10.06 |
| J9219 | Leuprolide acetate implant, 65 mg | 14 | $4,819.82 |
| J9220 | Injection, indigotindisulfonate sodium, 1 mg | 12 | $10.00 |
| J9223 | Injection, lurbinectedin, 0.1 mg | 31 | $210.78 |
| J9225 | Histrelin implant (vantas), 50 mg | 19 | $5,166.29 |
| J9226 | Histrelin implant (supprelin la), 50 mg | 28 | $37,880.45 |
| J9227 | Injection, isatuximab-irfc, 10 mg | 32 | $84.30 |
| J9228 | Injection, ipilimumab, 1 mg | 32 | $186.91 |
| J9229 | Injection, inotuzumab ozogamicin, 0.1 mg | 30 | $2,816.77 |
| J9230 | Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg | 17 | $316.88 |
| J9232 | Injection, docetaxel (hospira), not therapeutically equivalent to j9171, 1 mg | 16 | $0.51 |
| J9245 | Injection, melphalan hydrochloride, not otherwise specified, 50 mg | 32 | $104.90 |
| J9246 | Injection, melphalan (evomela), 1 mg | 27 | $18.24 |
| J9248 | Injection, melphalan (hepzato), 1 mg | 20 | $795.00 |
| J9249 | Injection, melphalan (apotex), 1 mg | 14 | $61.11 |
| J9256 | Injection, nipocalimab-aahu, 3 mg | 24 | $32.57 |
| J9260 | Injection, methotrexate sodium, 50 mg | 31 | $2.94 |
| J9261 | Injection, nelarabine, 50 mg | 30 | $65.41 |
| J9262 | Injection, omacetaxine mepesuccinate, 0.01 mg | 26 | $3.95 |
| J9263 | Injection, oxaliplatin, 0.5 mg | 30 | $0.06 |
| J9264 | Injection, paclitaxel protein-bound particles, 1 mg | 32 | $7.63 |
| J9266 | Injection, pegaspargase, per single dose vial | 32 | $28,424.06 |
| J9267 | Injection, paclitaxel, 1 mg | 29 | $0.11 |
| J9268 | Injection, pentostatin, 10 mg | 31 | $2,697.98 |
| J9269 | Injection, tagraxofusp-erzs, 10 micrograms | 31 | $351.04 |
| J9271 | Injection, pembrolizumab, 1 mg | 33 | $60.47 |
| J9272 | Injection, dostarlimab-gxly, 10 mg | 31 | $247.08 |
| J9273 | Injection, tisotumab vedotin-tftv, 1 mg | 28 | $196.07 |
| J9274 | Injection, tebentafusp-tebn, 1 microgram | 30 | $222.21 |
| J9276 | Injection, zanidatamab-hrii, 2 mg | 26 | $25.08 |
| J9277 | Injection, pembrolizumab, 1 mg and berahyaluronidase alfa-pmph | 21 | $31.94 |
| J9278 | Injection, carboplatin (avyxa), 1 mg | 19 | $5.20 |
| J9280 | Injection, mitomycin, 5 mg | 33 | $34.11 |
| J9281 | Mitomycin pyelocalyceal instillation, 1 mg | 29 | $323.17 |
| J9282 | Mitomycin, intravesical instillation, 1 mg | 18 | $274.34 |
| J9285 | Injection, olaratumab, 10 mg | 17 | $52.07 |
| J9286 | Injection, glofitamab-gxbm, 2.5 mg | 29 | $2,842.14 |
| J9289 | Injection, nivolumab, 2 mg and hyaluronidase-nvhy | 27 | $28.14 |
| J9292 | Injection, pemetrexed dipotassium, 10 mg | 26 | $78.21 |
| J9293 | Injection, mitoxantrone hydrochloride, per 5 mg | 33 | $30.88 |
| J9294 | Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg | 29 | $3.62 |
| J9295 | Injection, necitumumab, 1 mg | 29 | $5.73 |
| J9296 | Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg | 31 | $9.66 |
| J9297 | Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg | 29 | $4.87 |
| J9298 | Injection, nivolumab and relatlimab-rmbw, 3 mg/1 mg | 31 | $201.65 |
| J9299 | Injection, nivolumab, 1 mg | 33 | $33.60 |
| J9301 | Injection, obinutuzumab, 10 mg | 33 | $81.63 |
| J9302 | Injection, ofatumumab, 10 mg | 28 | $62.23 |
| J9303 | Injection, panitumumab, 10 mg | 32 | $173.67 |
| J9304 | Injection, pemetrexed (pemfexy), 10 mg | 29 | $34.50 |
| J9305 | Injection, pemetrexed, not otherwise specified, 10 mg | 32 | $5.27 |
| J9306 | Injection, pertuzumab, 1 mg | 32 | $17.01 |
| J9307 | Injection, pralatrexate, 1 mg | 32 | $386.12 |
| J9308 | Injection, ramucirumab, 5 mg | 33 | $75.58 |
| J9309 | Injection, polatuzumab vedotin-piiq, 1 mg | 32 | $137.00 |
| J9311 | Injection, rituximab 10 mg and hyaluronidase | 32 | $36.39 |
| J9312 | Injection, rituximab, 10 mg | 32 | $73.28 |
| J9313 | Injection, moxetumomab pasudotox-tdfk, 0.01 mg | 27 | $23.39 |
| J9314 | Injection, pemetrexed (teva), not therapeutically equivalent to j9305, 10 mg | 28 | $10.99 |
| J9316 | Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg | 30 | $60.46 |
| J9317 | Injection, sacituzumab govitecan-hziy, 2.5 mg | 32 | $36.98 |
| J9318 | Injection, romidepsin, non-lyophilized, 0.1 mg | 28 | $28.52 |
| J9319 | Injection, romidepsin, lyophilized, 0.1 mg | 30 | $30.71 |
| J9320 | Injection, streptozocin, 1 gram | 26 | $370.18 |
| J9321 | Injection, epcoritamab-bysp, 0.16 mg | 31 | $56.81 |
| J9322 | Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg | 20 | $9.96 |
| J9323 | Injection, pemetrexed ditromethamine, 10 mg | 27 | $1.06 |
| J9324 | Injection, pemetrexed (pemrydi rtu), 10 mg | 26 | $71.25 |
| J9325 | Injection, talimogene laherparepvec, per 1 million plaque forming units | 31 | $73.94 |
| J9326 | Injection, telisotuzumab vedotin-tllv, 1 mg | 26 | $145.99 |
| J9328 | Injection, temozolomide, 1 mg | 31 | $10.40 |
| J9329 | Injection, tislelizumab-jsgr, 1mg | 28 | $58.17 |
| J9330 | Injection, temsirolimus, 1 mg | 32 | $32.68 |
| J9331 | Injection, sirolimus protein-bound particles, 1 mg | 30 | $88.02 |
| J9332 | Injection, efgartigimod alfa-fcab, 2mg | 29 | $32.22 |
| J9333 | Injection, rozanolixizumab-noli, 1 mg | 29 | $23.49 |
| J9334 | Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc | 30 | $34.25 |
| J9341 | Injection, thiotepa (tepylute), 1 mg | 24 | $36.70 |
| J9342 | Injection, thiotepa, not otherwise specified, 1 mg | 25 | $6.70 |
| J9345 | Injection, retifanlimab-dlwr, 1 mg | 30 | $30.53 |
| J9347 | Injection, tremelimumab-actl, 1 mg | 30 | $143.02 |
| J9348 | Injection, naxitamab-gqgk, 1 mg | 29 | $684.89 |
| J9349 | Injection, tafasitamab-cxix, 2 mg | 30 | $14.24 |
| J9350 | Injection, mosunetuzumab-axgb, 1 mg | 30 | $655.38 |
| J9351 | Injection, topotecan, 0.1 mg | 31 | $2.76 |
| J9352 | Injection, trabectedin, 0.1 mg | 32 | $391.07 |
| J9353 | Injection, margetuximab-cmkb, 5 mg | 26 | $53.75 |
| J9354 | Injection, ado-trastuzumab emtansine, 1 mg | 32 | $42.19 |
| J9355 | Injection, trastuzumab, excludes biosimilar, 10 mg | 33 | $72.32 |
| J9356 | Injection, trastuzumab, 10 mg and hyaluronidase-oysk | 32 | $59.91 |
| J9357 | Injection, valrubicin, intravesical, 200 mg | 30 | $1,247.05 |
| J9358 | Injection, fam-trastuzumab deruxtecan-nxki, 1 mg | 32 | $31.30 |
| J9359 | Injection, loncastuximab tesirine-lpyl, 0.075 mg | 29 | $221.22 |
| J9360 | Injection, vinblastine sulfate, 1 mg | 32 | $5.52 |
| J9370 | Vincristine sulfate, 1 mg | 32 | $9.52 |
| J9376 | Injection, pozelimab-bbfg, 1 mg | 20 | $86.54 |
| J9380 | Injection, teclistamab-cqyv, 0.5 mg | 30 | $34.58 |
| J9381 | Injection, teplizumab-mzwv, 5 mcg | 29 | $38.39 |
| J9382 | Injection, zenocutuzumab-zbco, 1 mg | 25 | $33.57 |
| J9390 | Injection, vinorelbine tartrate, 10 mg | 32 | $4.91 |
| J9393 | Injection, fulvestrant (teva), not therapeutically equivalent to j9395, 25 mg | 24 | $21.00 |
| J9394 | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg | 30 | $27.11 |
| J9395 | Injection, fulvestrant, 25 mg | 32 | $5.72 |
| J9400 | Injection, ziv-aflibercept, 1 mg | 32 | $8.67 |
| J9600 | Injection, porfimer sodium, 75 mg | 20 | $18,603.95 |
| J9601 | Injection, linvoseltamab-gcpt, 1 mg | 20 | $99.31 |
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.