Price Transparency

Know your out-of-pocket cost for care.

All Charges

Charge

Type

Setting

Price

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.58

Service Code	NDC 69315090401
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: MDX Hawaii PPO	$3.47

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.68

Service Code	NDC 00591024005
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$3.13
Max. Negotiated Rate	$3.57
Rate for Payer: Cash Price	$2.39
Rate for Payer: Health Management Network Commercial	$3.13
Rate for Payer: Kaiser Permanente Commercial	$3.31
Rate for Payer: MDX Hawaii PPO	$3.57

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 00904600761
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 60687040101
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.58

Service Code	NDC 00591024001
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$3.04
Max. Negotiated Rate	$3.47
Rate for Payer: Cash Price	$2.33
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: MDX Hawaii PPO	$3.47

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 68084073601
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 68084073601
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.68

Service Code	NDC 00591024005
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.84
Max. Negotiated Rate	$3.57
Rate for Payer: AlohaCare Medicaid	$1.84
Rate for Payer: AlohaCare Medicare	$1.84
Rate for Payer: Cash Price	$2.39
Rate for Payer: Devoted Health Medicare	$2.02
Rate for Payer: Hawaii Medical Service Association Medicare	$1.84
Rate for Payer: Hawaii Western Management Group Commercial	$3.50
Rate for Payer: Health Management Network Commercial	$3.13
Rate for Payer: Humana Medicare	$1.84
Rate for Payer: Kaiser Permanente Commercial	$3.31
Rate for Payer: Kaiser Permanente Medicaid	$1.88
Rate for Payer: Kaiser Permanente Medicare	$1.84
Rate for Payer: MDX Hawaii PPO	$3.57
Rate for Payer: Ohana Health Plan Medicaid	$1.84
Rate for Payer: Ohana Health Plan Medicare	$1.84
Rate for Payer: UnitedHealthcare Medicaid	$2.21
Rate for Payer: UnitedHealthcare Medicare	$1.84
Rate for Payer: University Health Alliance Commercial	$2.68

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.58

Service Code	NDC 69315090401
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$3.47
Rate for Payer: AlohaCare Medicaid	$1.79
Rate for Payer: AlohaCare Medicare	$1.79
Rate for Payer: Cash Price	$2.33
Rate for Payer: Devoted Health Medicare	$1.97
Rate for Payer: Hawaii Medical Service Association Medicare	$1.79
Rate for Payer: Hawaii Western Management Group Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Humana Medicare	$1.79
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: Kaiser Permanente Medicaid	$1.83
Rate for Payer: Kaiser Permanente Medicare	$1.79
Rate for Payer: MDX Hawaii PPO	$3.47
Rate for Payer: Ohana Health Plan Medicaid	$1.79
Rate for Payer: Ohana Health Plan Medicare	$1.79
Rate for Payer: UnitedHealthcare Medicaid	$2.15
Rate for Payer: UnitedHealthcare Medicare	$1.79
Rate for Payer: University Health Alliance Commercial	$2.61

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 60687040101
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 0.5 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 60687062701
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 60687062701
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 00904600761
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 0.5 mg tablet [HHSC]

Facility

OP

$3.58

Service Code	NDC 00591024001
Hospital Charge Code	2500498
Hospital Revenue Code	250
Min. Negotiated Rate	$1.79
Max. Negotiated Rate	$3.47
Rate for Payer: AlohaCare Medicaid	$1.79
Rate for Payer: AlohaCare Medicare	$1.79
Rate for Payer: Cash Price	$2.33
Rate for Payer: Devoted Health Medicare	$1.97
Rate for Payer: Hawaii Medical Service Association Medicare	$1.79
Rate for Payer: Hawaii Western Management Group Commercial	$3.40
Rate for Payer: Health Management Network Commercial	$3.04
Rate for Payer: Humana Medicare	$1.79
Rate for Payer: Kaiser Permanente Commercial	$3.22
Rate for Payer: Kaiser Permanente Medicaid	$1.83
Rate for Payer: Kaiser Permanente Medicare	$1.79
Rate for Payer: MDX Hawaii PPO	$3.47
Rate for Payer: Ohana Health Plan Medicaid	$1.79
Rate for Payer: Ohana Health Plan Medicare	$1.79
Rate for Payer: UnitedHealthcare Medicaid	$2.15
Rate for Payer: UnitedHealthcare Medicare	$1.79
Rate for Payer: University Health Alliance Commercial	$2.61

LORazepam 1 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 68084074201
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 1 mg tablet [HHSC]

Facility

OP

$4.89

Service Code	NDC 00591024101
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$2.44
Max. Negotiated Rate	$4.74
Rate for Payer: AlohaCare Medicaid	$2.44
Rate for Payer: AlohaCare Medicare	$2.44
Rate for Payer: Cash Price	$3.18
Rate for Payer: Devoted Health Medicare	$2.69
Rate for Payer: Hawaii Medical Service Association Medicare	$2.44
Rate for Payer: Hawaii Western Management Group Commercial	$4.65
Rate for Payer: Health Management Network Commercial	$4.16
Rate for Payer: Humana Medicare	$2.44
Rate for Payer: Kaiser Permanente Commercial	$4.40
Rate for Payer: Kaiser Permanente Medicaid	$2.49
Rate for Payer: Kaiser Permanente Medicare	$2.44
Rate for Payer: MDX Hawaii PPO	$4.74
Rate for Payer: Ohana Health Plan Medicaid	$2.44
Rate for Payer: Ohana Health Plan Medicare	$2.44
Rate for Payer: UnitedHealthcare Medicaid	$2.93
Rate for Payer: UnitedHealthcare Medicare	$2.44
Rate for Payer: University Health Alliance Commercial	$3.56

LORazepam 1 mg tablet [HHSC]

Facility

IP

$4.89

Service Code	NDC 00591024101
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$4.16
Max. Negotiated Rate	$4.74
Rate for Payer: Cash Price	$3.18
Rate for Payer: Health Management Network Commercial	$4.16
Rate for Payer: Kaiser Permanente Commercial	$4.40
Rate for Payer: MDX Hawaii PPO	$4.74

LORazepam 1 mg tablet [HHSC]

Facility

OP

$4.66

Service Code	NDC 69315090501
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$2.33
Max. Negotiated Rate	$4.52
Rate for Payer: AlohaCare Medicaid	$2.33
Rate for Payer: AlohaCare Medicare	$2.33
Rate for Payer: Cash Price	$3.03
Rate for Payer: Devoted Health Medicare	$2.56
Rate for Payer: Hawaii Medical Service Association Medicare	$2.33
Rate for Payer: Hawaii Western Management Group Commercial	$4.43
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Humana Medicare	$2.33
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: Kaiser Permanente Medicaid	$2.38
Rate for Payer: Kaiser Permanente Medicare	$2.33
Rate for Payer: MDX Hawaii PPO	$4.52
Rate for Payer: Ohana Health Plan Medicaid	$2.33
Rate for Payer: Ohana Health Plan Medicare	$2.33
Rate for Payer: UnitedHealthcare Medicaid	$2.80
Rate for Payer: UnitedHealthcare Medicare	$2.33
Rate for Payer: University Health Alliance Commercial	$3.40

LORazepam 1 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 60687035501
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 1 mg tablet [HHSC]

Facility

IP

$4.66

Service Code	NDC 69315090501
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$3.96
Max. Negotiated Rate	$4.52
Rate for Payer: Cash Price	$3.03
Rate for Payer: Health Management Network Commercial	$3.96
Rate for Payer: Kaiser Permanente Commercial	$4.19
Rate for Payer: MDX Hawaii PPO	$4.52

LORazepam 1 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 60687035501
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 1 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 60687063801
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 1 mg tablet [HHSC]

Facility

IP

$3.00

Service Code	NDC 00904600861
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$2.55
Max. Negotiated Rate	$2.91
Rate for Payer: Cash Price	$1.95
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: MDX Hawaii PPO	$2.91

LORazepam 1 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 00904600861
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

LORazepam 1 mg tablet [HHSC]

Facility

OP

$3.00

Service Code	NDC 68084074201
Hospital Charge Code	2500499
Hospital Revenue Code	250
Min. Negotiated Rate	$1.50
Max. Negotiated Rate	$2.91
Rate for Payer: AlohaCare Medicaid	$1.50
Rate for Payer: AlohaCare Medicare	$1.50
Rate for Payer: Cash Price	$1.95
Rate for Payer: Devoted Health Medicare	$1.65
Rate for Payer: Hawaii Medical Service Association Medicare	$1.50
Rate for Payer: Hawaii Western Management Group Commercial	$2.85
Rate for Payer: Health Management Network Commercial	$2.55
Rate for Payer: Humana Medicare	$1.50
Rate for Payer: Kaiser Permanente Commercial	$2.70
Rate for Payer: Kaiser Permanente Medicaid	$1.53
Rate for Payer: Kaiser Permanente Medicare	$1.50
Rate for Payer: MDX Hawaii PPO	$2.91
Rate for Payer: Ohana Health Plan Medicaid	$1.50
Rate for Payer: Ohana Health Plan Medicare	$1.50
Rate for Payer: UnitedHealthcare Medicaid	$1.80
Rate for Payer: UnitedHealthcare Medicare	$1.50
Rate for Payer: University Health Alliance Commercial	$2.19

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