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
Average
$2.4k
Median
$2.2k
High
$18.1k
Each hospital's average Molina rate, under the methodology and billing class chosen below.
47 hospitals; the 90th percentile is 770.5× the 10th. Each bar is a price range and its height is how many hospitals fall in it. Hover a bar, or a row in the ladder, for details.
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54 hospital rates
iThe hospitals that file a Molina rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | AKRON GENERAL MEDICAL CENTER Akron, OH facility · case rate · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 2 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH per diem · inpatient | 2 | $5.4k | $5.4k | — | — | — | $5.4k – $5.4k |
| 3 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · inpatientfrom % of charges | 2 | $2.7k | $2.7k | $2 | 0% | — | $2.7k – $2.7k |
| 4 | ARTHUR G JAMES CANCER HOSPITAL AND RESEARCH INSTITUTE Columbus, OH percent of total billed charges · outpatientfrom % of charges | 4 | $2.0k | $2.1k | $259 | 12% | — | $1.9k – $2.5k |
| 5 | Amisub of South Carolina, Inc. Fort Mill, SC fee schedule · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 6 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE other · outpatient | 1 | $1.0k | $1.0k | — | — | — | $1.0k – $1.0k |
| 7 | BELLEVUE MEDICAL CENTER LLC Bellevue, NE percent of total billed charges · outpatientfrom % of charges | 1 | $440 | $440 | — | — | — | $440 – $440 |
| 8 | Beaufort Memorial Hospital Beaufort, SC facility · fee schedule · outpatient | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 9 | CLEVELAND CLINIC AVON HOSPITAL Avon, OH facility · case rate · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 10 | CLEVELAND CLINIC CHILDREN'S HOSPITAL FOR REHABILITATION Cleveland, OH facility · case rate · outpatient | 1 | $15 | $15 | — | — | — | $15 – $15 |
| 11 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Mentor, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 12 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Euclid, OH facility · case rate · outpatient | 1 | $9 | $9 | — | — | — | $9 – $9 |
| 13 | CLEVELAND CLINIC HEALTH SYSTEM - EAST REGION Warrensville Heights, OH facility · case rate · outpatient | 1 | $10 | $10 | — | — | — | $10 – $10 |
| 14 | Carolinas Medical Center Charlotte, NC fee schedule · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 15 | Carolinas Medical Center Charlotte, NC fee schedule · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 16 | Carolinas Medical Center Charlotte, NC fee schedule · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
| 17 | Childrens Hospital Colorado Aurora, CO percent of total billed charges · inpatientfrom % of charges | 1 | $18.1k | $18.1k | $6.0k | 33% | — | $12.0k – $24.1k |
| 18 | Childrens Hospital Colorado Aurora, CO percent of total billed charges · outpatientfrom % of charges | 1 | $18.1k | $18.1k | $6.0k | 33% | — | $12.0k – $24.1k |
| 19 | Childrens Hospital of Los Angeles Angeles, CA facility · percent of total billed charges · inpatientfrom % of charges | 1 | $1.7k | $1.3k | $561 | 42% | — | $547 – $1.7k |
| 20 | Childrens Hospital of Los Angeles Angeles, CA facility · percent of total billed charges · outpatientfrom % of charges | 1 | $1.7k | $1.3k | $561 | 42% | — | $547 – $1.7k |
| 21 | Childrens Hospital of Los Angeles Angeles, CA professional · fee schedule · outpatient | 1 | $1.7k | $1.3k | $561 | 42% | — | $547 – $1.7k |
| 22 | Cleveland Clinic Mercy Hospital Canton, OH facility · case rate · outpatient | 1 | $8 | $8 | — | — | — | $8 – $8 |
| 23 | Columbus Regional Healthcare System, Inc Whiteville, NC case rate · inpatient | 1 | $2.3k | $2.3k | — | — | — | $2.3k – $2.3k |
| 24 | ERIE COUNTY MEDICAL CENTER CORPORATION Buffalo, NY fee schedule · outpatient | 3 | $2.3k | $3.2k | $1.3k | 42% | — | $2.3k – $5.1k |
| 25 | East Cooper Medical Center LLC Mt Pleasant, SC fee schedule · outpatient | 1 | $2.2k | $2.2k | — | — | — | $2.2k – $2.2k |
← Payers reporting HCPCS J2787 · Snapshot 20261111T120946Z-9134e7f7