NDC 115180401
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
00115-1804-01 - hydrOXYzine pamoate 50 mg Cap
Reported by 8 hospitals in the network under the other methodology.
Based on 60–96 billing samples across every hospital reporting.
Low
$2
Average
$7
Median
$6
High
$19
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Reflects a payer-specific billing methodology not covered by the standard categories.
Showing only prices reported under the other methodology. Choose another in the filter above to change the chart. 8 hospitals; the 90th percentile is 6.1× 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.
Click a bar to filter the hospitals table to that price range.
| # | Hospital | Location | Approximate number of payer billing records behind this hospital’s price. CMS privacy rules cap small counts as a range (e.g. “1–10”) rather than an exact number — more samples means a more reliable price. | |||||
|---|---|---|---|---|---|---|---|---|
| 1 | Victoria of Texas LP | Victoria, TX | $4 | $6 | $6 | 30–48 | $1 | $21 |
| 2 | Victoria of Texas LP | Victoria, TX | $4 | $6 | $6 | 30–48 | $1 | $21 |
| 3 | St. Joseph Health System, LLC | Wayne, IN | $6 | $6 | — | — | $1 | $6 |
| 4 | Affinity Hospital LLC | Birmingham, AL | $19 | $19 | $5 | — | $4 | $24 |
| 5 | Gadsden Regional Medical Center LLC | Gadsden, AL | $2 | $2 | — | — | $2 | $2 |
| 6 | HMA Santa Rosa Medical Center LLC | Milton, FL | $3 | $10 | $20 | — | $1 | $63 |
| 7 | Laredo Texas Hospital Company LP | Laredo, TX | $2 | $2 | $0 | — | $1 | $16 |
| 8 | Poplar Bluff Regional Medical Center LLC | Poplar Bluff, MO | $3 | $3 | — | — | $1 | $4 |
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