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 28 hospitals in the network under the percent of billed charges methodology.
Based on 464–518 billing samples across every hospital reporting.
Low
$1
Average
$4
Median
$2
High
$13
Filter by billing methodology
Reflects a negotiated percentage of total billed charges.
Showing only prices reported under the percent of billed charges methodology. Choose another in the filter above to change the chart. 28 hospitals; the 90th percentile is 9.4× 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 | Tri-City Medical Center | Oceanside, CA | $6 | $7 | $3 | 460–478 | $2 | $13 |
| 2 | Methodist Medical Center of Illinois | Peoria, IL | $1 | $1 | $0 | 3–30 | $0 | $2 |
| 3 | Proctor Community Hospital | Peoria, IL | $1 | $1 | $0 | 1–10 | $0 | $2 |
| 4 | IOM Health System LP | Fort Wayne, IN | $3 | $3 | $1 | — | $1 | $5 |
| 5 | Lutheran Musculoskeletal Center LLC | Fort Wayne, IN | $5 | $6 | $2 | — | $3 | $10 |
| 6 | St. Joseph Health System, LLC | Wayne, IN | $3 | $4 | $1 | — | $1 | $6 |
| 7 | Victoria of Texas LP | Victoria, TX | $9 | $11 | $6 | — | $1 | $21 |
| 8 | Victoria of Texas LP | Victoria, TX | $9 | $11 | $6 | — | $1 | $21 |
| 9 | Affinity Hospital LLC | Birmingham, AL | $14 | $13 | $5 | — | $4 | $22 |
| 10 | Gadsden Regional Medical Center LLC | Gadsden, AL | $1 | $1 | $1 | — | $0 | $1.5k |
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