J2787 — Riboflavin 5'phos Opth<=3ml
$4,108
All-payer median here
$6,840
Cash / self-pay here
22
payer/plan-name variants
Median over current-blob negotiated rates (COALESCE of standard / median / min–max midpoint, $0.01–$5M sentinel guard). Payers are canonical-grouped where a mapping exists; unmapped regional-plan name variants may appear as separate rows.