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
VANCOMYCIN 1 MG/0.1 ML OPHTH SOLN MFG INJ
The hospitals that file a Tricare 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.
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94 hospital rates
| # | Plans | |||
|---|---|---|---|---|
| 1 | Anderson Hospital Maryville, IL facility · fee schedule · outpatient | 1 | $60.12 | $14.25 – $119.96 |
| 2 | Anderson Hospital Maryville, IL professional · other · outpatient | 1 | $0.03 | $0.03 – $0.03 |
| 3 | Armstrong County Memorial Hospital Kittanning, PA facility · fee schedule · outpatient | 1 | $70.37 | $9.31 – $218.88 |
| 4 | Aspen Valley Hospital District Aspen, CO facility · percent of total billed charges · bothfrom % of charges | 4 | $36.39 | $5.41 – $146.01 |
| 5 | CORNING HOSPITAL Corning, NY facility · other · outpatient | 1 | $75.63 | $1.00 – $131.25 |
| 6 | Calhoun Liberty Hospital Association Inc Blountstown, FL percent of total billed charges · bothfrom % of charges | 1 | $11.62 | $5.22 – $18.02 |
| 7 | CentraState Medical Center Freehold Township, NJ other · outpatient | 2 | $14,242 | $14,242 – $14,242 |
| 8 | Chilton Medical Center Pompton Plains, NJ other · outpatient | 2 | $14,930 | $14,930 – $14,930 |
| 9 | Columbia Lutheran Charities Astoria, OR facility · percent of total billed charges · bothfrom % of charges | 1 | $68.09 | $36.65 – $113.60 |
| 10 | Conway Regional Medical Center Conway, AR facility · fee schedule · outpatient | 1 | $201.11 | $27.82 – $915.45 |
| 11 | Ellis Hospital NY 12308; 2210 Troy Schenectady Road Niskayuna, NY facility · fee schedule · outpatient | 1 | $73.80 | $20.15 – $139.50 |
| 12 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · inpatientfrom % of charges | 1 | $11.63 | $3.86 – $30.95 |
| 13 | Fisher-Titus Medical Center Norwalk, OH facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10.90 | $3.62 – $29.02 |
| 14 | GUTHRIE CORTLAND MEDICAL CENTER Cortland, NY facility · other · outpatient | 1 | $1.00 | $1.00 – $1.00 |
| 15 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · inpatientfrom % of charges | 1 | $11.90 | $6.60 – $19.97 |
| 16 | Garfield County, a political subdivision of the State of Utah, DBA Intermountain Health Garfield Memorial Hospital Panguitch, UT facility · percent of total billed charges · outpatientfrom % of charges | 1 | $10.01 | $5.55 – $16.79 |
| 17 | HOULTON REGIONAL HOSPITAL HOULTON, ME percent of total billed charges · bothfrom % of charges | 1 | $18.54 | $9.54 – $28.38 |
| 18 | HSA CGH LLC Coral Gables, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $87.37 | $14.74 – $179.76 |
| 19 | HSA PGH LLC Hialeah, FL facility · percent of total billed charges · outpatientfrom % of charges | 1 | $87.37 | $14.74 – $179.76 |
| 20 | Hackettstown Medical Center Hackettstown, NJ other · outpatient | 2 | $3,439 | $3,439 – $3,439 |
| 21 | Hemet Global Medical Center Hemet, CA facility · fee schedule · outpatient | 1 | $44.00 | $30.00 – $56.00 |
| 22 | Hemet Global Medical Center Hemet, CA professional · fee schedule · outpatient | 1 | $1.29 | $0.03 – $2.55 |
| 23 | Holy Cross Germantown Hospital Germantown, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $94.63 | $2.97 – $242.70 |
| 24 | Holy Cross Hospital-Silver Spring Silver Spring, MD facility · percent of total billed charges · bothfrom % of charges | 1 | $71.32 | $2.97 – $293.98 |
| 25 | Hospital Service District #1, Parish of Terrebonne, State of Louisiana dba Terrebonne General Health System Houma, LA facility · fee schedule · outpatient | 1 | $325.32 | $19.47 – $1,434 |
← Payers reporting HCPCS J3373 · Snapshot 20261109T115250Z-6452cf6e