| Code | Description | States | Median rate |
|---|---|---|---|
| Q9950 | Injection, sulfur hexafluoride lipid microspheres, per ml | 20 | $18.17 |
| Q9953 | Injection, iron-based magnetic resonance contrast agent, per ml | 13 | $62.05 |
| Q9954 | Oral magnetic resonance contrast agent, per 100 ml | 12 | $11.15 |
| Q9956 | Injection, octafluoropropane microspheres, per ml | 21 | $40.85 |
| Q9957 | Injection, perflutren lipid microspheres, per ml | 24 | $40.85 |
| Q9958 | High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml | 17 | $0.08 |
| Q9960 | High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml | 12 | $0.16 |
| Q9961 | High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml | 19 | $0.22 |
| Q9962 | High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml | 12 | $0.18 |
| Q9963 | High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml | 19 | $0.21 |
| Q9964 | High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml | 10 | $0.30 |
| Q9965 | Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml | 25 | $0.89 |
| Q9966 | Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml | 28 | $0.44 |
| Q9967 | Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml | 30 | $0.16 |
| Q9968 | Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg | 18 | $4.69 |
| Q9982 | Flutemetamol f18, diagnostic, per study dose, up to 5 millicuries | 13 | $2,385.34 |
| Q9983 | Florbetaben f18, diagnostic, per study dose, up to 8.1 millicuries | 16 | $1,584.67 |
| Q9991 | Injection, buprenorphine extended-release (sublocade), less than or equal to 100 mg | 30 | $2,016.42 |
| Q9992 | Injection, buprenorphine extended-release (sublocade), greater than 100 mg | 30 | $2,001.02 |
| Q9997 | Injection, ustekinumab-ttwe (pyzchiva), intravenous, 1 mg | 23 | $8.55 |
| Q9998 | Injection, ustekinumab-aekn (selarsdi), biosimilar, 1 mg | 22 | $38.33 |
| Q9999 | Injection, ustekinumab-aauz (otulfi), biosimilar, 1 mg | 22 | $14.78 |
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.