| Code | Description | States | Median rate |
|---|---|---|---|
| Q5098 | Injection, ustekinumab-srlf (imuldosa), biosimilar, 1 mg | 16 | $11.55 |
| Q5099 | Injection, ustekinumab-stba (steqeyma), biosimilar, 1 mg | 24 | $3.08 |
| Q5100 | Injection, ustekinumab-kfce (yesintek), biosimilar, 1 mg | 24 | $3.29 |
| Q5101 | Injection, filgrastim-sndz, biosimilar, (zarxio), 1 microgram | 30 | $0.35 |
| Q5103 | Injection, infliximab-dyyb, biosimilar, (inflectra), 10 mg | 31 | $27.71 |
| Q5104 | Injection, infliximab-abda, biosimilar, (renflexis), 10 mg | 32 | $26.62 |
| Q5105 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for esrd on dialysis), 100 units | 28 | $0.79 |
| Q5106 | Injection, epoetin alfa-epbx, biosimilar, (retacrit) (for non-esrd use), 1000 units | 32 | $7.97 |
| Q5107 | Injection, bevacizumab-awwb, biosimilar, (mvasi), 10 mg | 32 | $24.53 |
| Q5108 | Injection, pegfilgrastim-jmdb (fulphila), biosimilar, 0.5 mg | 33 | $96.52 |
| Q5110 | Injection, filgrastim-aafi, biosimilar, (nivestym), 1 microgram | 29 | $0.32 |
| Q5111 | Injection, pegfilgrastim-cbqv (udenyca), biosimilar, 0.5 mg | 31 | $149.13 |
| Q5112 | Injection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mg | 28 | $25.71 |
| Q5113 | Injection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mg | 29 | $54.94 |
| Q5114 | Injection, trastuzumab-dkst, biosimilar, (ogivri), 10 mg | 31 | $37.71 |
| Q5115 | Injection, rituximab-abbs, biosimilar, (truxima), 10 mg | 31 | $34.56 |
| Q5116 | Injection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mg | 30 | $13.03 |
| Q5117 | Injection, trastuzumab-anns, biosimilar, (kanjinti), 10 mg | 31 | $59.40 |
| Q5118 | Injection, bevacizumab-bvzr, biosimilar, (zirabev), 10 mg | 30 | $25.85 |
| Q5119 | Injection, rituximab-pvvr, biosimilar, (ruxience), 10 mg | 32 | $16.16 |
| Q5120 | Injection, pegfilgrastim-bmez (ziextenzo), biosimilar, 0.5 mg | 30 | $130.87 |
| Q5121 | Injection, infliximab-axxq, biosimilar, (avsola), 10 mg | 32 | $30.83 |
| Q5122 | Injection, pegfilgrastim-apgf (nyvepria), biosimilar, 0.5 mg | 30 | $135.64 |
| Q5123 | Injection, rituximab-arrx, biosimilar, (riabni), 10 mg | 31 | $20.90 |
| Q5124 | Injection, ranibizumab-nuna, biosimilar, (byooviz), 0.1 mg | 27 | $223.74 |
| Q5125 | Injection, filgrastim-ayow, biosimilar, (releuko), 1 microgram | 29 | $0.33 |
| Q5126 | Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg | 28 | $57.49 |
| Q5127 | Injection, pegfilgrastim-fpgk (stimufend), biosimilar, 0.5 mg | 30 | $150.61 |
| Q5128 | Injection, ranibizumab-eqrn (cimerli), biosimilar, 0.1 mg | 30 | $83.47 |
| Q5129 | Injection, bevacizumab-adcd (vegzelma), biosimilar, 10 mg | 28 | $38.06 |
| Q5130 | Injection, pegfilgrastim-pbbk (fylnetra), biosimilar, 0.5 mg | 29 | $127.23 |
| Q5133 | Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg | 26 | $5.19 |
| Q5134 | Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg | 15 | $24.49 |
| Q5135 | Injection, tocilizumab-aazg (tyenne), biosimilar, 1 mg | 29 | $4.19 |
| Q5136 | Injection, denosumab-bbdz (jubbonti/wyost), biosimilar, 1 mg | 22 | $27.67 |
| Q5138 | Injection, ustekinumab-auub (wezlana), biosimilar, intravenous, 1 mg | 16 | $7.30 |
| Q5140 | Injection, adalimumab-fkjp, biosimilar, 1 mg | 16 | $24.88 |
| Q5141 | Injection, adalimumab-aaty, biosimilar, 1 mg | 16 | $25.95 |
| Q5142 | Injection, adalimumab-ryvk biosimilar, 1 mg | 17 | $12.98 |
| Q5143 | Injection, adalimumab-adbm, biosimilar, 1 mg | 16 | $17.26 |
| Q5144 | Injection, adalimumab-aacf (idacio), biosimilar, 1 mg | 17 | $15.02 |
| Q5145 | Injection, adalimumab-afzb (abrilada), biosimilar, 1 mg | 16 | $21.30 |
| Q5146 | Injection, trastuzumab-strf (hercessi), biosimilar, 10 mg | 24 | $36.84 |
| Q5147 | Injection, aflibercept-ayyh (pavblu), biosimilar, 1 mg | 28 | $803.26 |
| Q5148 | Injection, filgrastim-txid (nypozi), biosimilar, 1 microgram | 20 | $1.03 |
| Q5151 | Injection, eculizumab-aagh (epysqli), biosimilar, 2 mg | 20 | $31.77 |
| Q5152 | Injection, eculizumab-aeeb (bkemv), biosimilar, 2 mg | 20 | $41.16 |
| Q5156 | Injection, tocilizumab-anoh (avtozma), biosimilar, 1 mg | 18 | $4.69 |
| Q5157 | Injection, denosumab-bmwo (stoboclo/osenvelt), biosimilar, 1 mg | 21 | $25.98 |
| Q5158 | Injection, denosumab-bnht (bomyntra/conexxence), biosimilar, 1 mg | 20 | $28.82 |
| Q5160 | Injection, bevacizumab-nwgd (jobevne), biosimilar, 10 mg | 18 | $82.24 |
| Q5161 | Injection, denosumab-kyqq (aukelso/bosaya), biosimilar, 1 mg | 15 | $25.00 |
| Q5162 | Injection, denosumab-nxxp (bildyos/bilprevda), biosimilar, 1 mg | 17 | $15.66 |
| Q5164 | Injection, ustekinumab-hmny (starjemza), biosimilar, 1 mg | 12 | $4.52 |
| Q5166 | Injection, denosumab-desu (osvyrti/jubereq), biosimilar, 1 mg | 10 | $28.80 |
| Q5167 | Injection, denosumab-qbde (enoby/xtrenbo), biosimilar, 1 mg | 15 | $4.12 |
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.