Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
RIBOFLAV5 & RIBOFLAV5-DEXTRAN 0.146 &0.146-20 % OPHTH SOSY
Low
$1.2k
Average
$5.0k
Median
$4.1k
High
$14.7k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
45 payers; the 90th percentile is 5.2× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | UnitedHealthcare fee schedule · outpatient · +18 other terms | 371 | $4.5k | $4.7k | $2.3k | 49% | — | $1 – $18.5k |
| 2 | Cigna fee schedule · outpatient · +13 other terms | 181 | $4.4k | $7.0k | $5.1k | 73% | — | $1.6k – $19.9k |
| 3 | Blue Cross Blue Shield fee schedule · outpatient · +14 other terms | 157 | $3.5k | $4.7k | $3.4k | 72% | — | $1 – $29.4k |
| 4 | Aetna fee schedule · outpatient · +17 other terms | 115 | $3.8k | $4.3k | $2.5k | 59% | — | $1 – $21.6k |
| 5 | Anthem fee schedule · outpatient · +13 other terms | 37 | $2.5k | $3.9k | $1.7k | 45% | — | $2.2k – $10.8k |
| 6 | Bcbs Tx fee schedule · outpatient · +1 other terms | 30 | $6.2k | $5.6k | $1.9k | 33% | — | $2.3k – $9.7k |
| 7 | Humana fee schedule · outpatient · +13 other terms | 17 | $2.2k | $3.7k | $2.4k | 64% | — | $1 – $7.3k |
| 8 | Caresource facility · case rate · outpatient · +4 other terms | 15 | $9 | $10 | $2 | 23% | — | $6 – $15 |
| 9 | Molina facility · case rate · outpatient · +13 other terms | 15 | $9 | $10 | $2 | 23% | — | $6 – $15 |
| 10 | Beechstreet percent of total billed charges · outpatientfrom % of charges · +2 other terms | 13 | $14.9k | $14.1k | $3.2k | 23% | — | $3.1k – $15.9k |
| 11 | Medcost percent of total billed charges · inpatientfrom % of charges · +1 other terms | 13 | $9.4k | $10.6k | $3.2k | 30% | — | $5.1k – $22.8k |
| 12 | Wellmark fee schedule · both · +5 other terms | 13 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 13 | Ambetter percent of total billed charges · outpatientfrom % of charges · +2 other terms | 12 | $5.6k | $5.8k | $1.0k | 18% | — | $4.8k – $9.2k |
| 14 | Bcbs Mn fee schedule · outpatient · +6 other terms | 12 | $1.1k | $1.1k | $579 | 54% | — | $1 – $2.3k |
| 15 | Bcbs Nj fee schedule · outpatient · +4 other terms | 12 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 16 | Highmark fee schedule · outpatient · +6 other terms | 12 | $2.6k | $2.6k | $244 | 9% | — | $2.3k – $5.1k |
| 17 | Optum facility · case rate · outpatient · +10 other terms | 11 | $8 | $9 | $2 | 22% | — | $7 – $13 |
| 18 | Medica fee schedule · outpatient · +10 other terms | 10 | $3.9k | $4.0k | $998 | 25% | — | $2.4k – $5.1k |
| 19 | Ucare fee schedule · both · +5 other terms | 9 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 20 | Aetna Better Health fee schedule · inpatient · +4 other terms | 7 | $2.1k | $2.1k | — | — | — | $2.1k – $2.1k |
| 21 | Tricare facility · fee schedule · outpatient | 7 | $11.2k | $9.3k | $6.7k | 72% | — | $0 – $16.4k |
| 22 | Bcbs La fee schedule · outpatient · +1 other terms | 6 | $1.7k | $1.8k | $237 | 13% | — | $1.7k – $2.5k |
| 23 | Clover facility · other · outpatient | 5 | $16.4k | $13.4k | $4.7k | 35% | — | $6k – $16.4k |
| 24 | Excellus facility · fee schedule · outpatient | 5 | $3.8k | $4.2k | $2.6k | 60% | — | $2.4k – $10.9k |
| 25 | First Health facility · fee schedule · outpatient · +7 other terms | 4 | $5.7k | $5.7k | — | — | — | $5.7k – $5.7k |
← Hospitals reporting HCPCS J2787 · Snapshot 20261111T120946Z-9134e7f7