St. Barnabas Hospital

All Charges

Charge

Type

Setting

Price

DULOXETINE 20 MG DR CAP

Facility

$9.79

Hospital Charge Code	41655093
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$7.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.90
Rate for Payer: Aetna Government	$4.90
Rate for Payer: Brighton Health Commercial	$7.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.66
Rate for Payer: Group Health Inc Commercial	$4.90
Rate for Payer: Group Health Inc Medicare	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.36

DULOXETINE 20 MG DR CAP

Facility

$9.79

Hospital Charge Code	41645093
Hospital Revenue Code	250
Min. Negotiated Rate	$3.43
Max. Negotiated Rate	$7.83
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.38
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.90
Rate for Payer: Aetna Government	$4.90
Rate for Payer: Brighton Health Commercial	$7.34
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.83
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.66
Rate for Payer: Group Health Inc Commercial	$4.90
Rate for Payer: Group Health Inc Medicare	$3.43
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.90
Rate for Payer: Hamaspik Choice Inc Medicare	$4.90
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$6.36

DULOXETINE 30 MG DR CAP

Facility

$10.96

Hospital Charge Code	41655094
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Brighton Health Commercial	$8.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE 30 MG DR CAP

Facility

$10.96

Hospital Charge Code	41645094
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Brighton Health Commercial	$8.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE 60 MG DR CAP

Facility

$10.96

Hospital Charge Code	41655095
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Brighton Health Commercial	$8.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE 60 MG DR CAP

Facility

$10.96

Hospital Charge Code	41645095
Hospital Revenue Code	250
Min. Negotiated Rate	$3.84
Max. Negotiated Rate	$8.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$6.03
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$5.48
Rate for Payer: Aetna Government	$5.48
Rate for Payer: Brighton Health Commercial	$8.22
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$8.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$7.45
Rate for Payer: Group Health Inc Commercial	$5.48
Rate for Payer: Group Health Inc Medicare	$3.84
Rate for Payer: Hamaspik Choice Inc Medicaid	$5.48
Rate for Payer: Hamaspik Choice Inc Medicare	$5.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$7.12

DULOXETINE HCL 20 MG PO CPEP [39275]

Facility

$7.00

Service Code	NDC 27241009706
Hospital Charge Code	27241009706
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DULOXETINE HCL 20 MG PO CPEP [39275]

Facility

$8.17

Service Code	NDC 50268028615
Hospital Charge Code	50268028615
Hospital Revenue Code	250
Min. Negotiated Rate	$2.86
Max. Negotiated Rate	$6.53
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.49
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.08
Rate for Payer: Aetna Government	$4.08
Rate for Payer: Brighton Health Commercial	$6.12
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.53
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.55
Rate for Payer: Group Health Inc Commercial	$4.08
Rate for Payer: Group Health Inc Medicare	$2.86
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.08
Rate for Payer: Hamaspik Choice Inc Medicare	$4.08
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.31

DULOXETINE HCL 20 MG PO CPEP [39275]

Facility

$1.75

Service Code	NDC 00904704304
Hospital Charge Code	00904704304
Hospital Revenue Code	250
Min. Negotiated Rate	$0.61
Max. Negotiated Rate	$1.40
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.96
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.87
Rate for Payer: Aetna Government	$0.87
Rate for Payer: Brighton Health Commercial	$1.31
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.40
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.19
Rate for Payer: Group Health Inc Commercial	$0.87
Rate for Payer: Group Health Inc Medicare	$0.61
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.87
Rate for Payer: Hamaspik Choice Inc Medicare	$0.87
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.14

DULOXETINE HCL 20 MG PO CPEP [39275]

Facility

$7.00

Service Code	NDC 57237001760
Hospital Charge Code	57237001760
Hospital Revenue Code	250
Min. Negotiated Rate	$2.45
Max. Negotiated Rate	$5.60
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.85
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.50
Rate for Payer: Aetna Government	$3.50
Rate for Payer: Brighton Health Commercial	$5.25
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$5.60
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.76
Rate for Payer: Group Health Inc Commercial	$3.50
Rate for Payer: Group Health Inc Medicare	$2.45
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.50
Rate for Payer: Hamaspik Choice Inc Medicare	$3.50
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$4.55

DULOXETINE HCL 30 MG PO CPEP [39276]

Facility

$7.85

Service Code	NDC 57237001830
Hospital Charge Code	57237001830
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 30 MG PO CPEP [39276]

Facility

$7.84

Service Code	NDC 43547038003
Hospital Charge Code	43547038003
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$6.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.92
Rate for Payer: Aetna Government	$3.92
Rate for Payer: Brighton Health Commercial	$5.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.33
Rate for Payer: Group Health Inc Commercial	$3.92
Rate for Payer: Group Health Inc Medicare	$2.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 30 MG PO CPEP [39276]

Facility

$7.70

Service Code	NDC 68084068301
Hospital Charge Code	68084068301
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

DULOXETINE HCL 30 MG PO CPEP [39276]

Facility

$5.93

Service Code	NDC 50268028713
Hospital Charge Code	50268028713
Hospital Revenue Code	250
Min. Negotiated Rate	$2.07
Max. Negotiated Rate	$4.74
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$3.26
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$2.96
Rate for Payer: Aetna Government	$2.96
Rate for Payer: Brighton Health Commercial	$4.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$4.74
Rate for Payer: Cigna LocalPlus Benefit Plan	$4.03
Rate for Payer: Group Health Inc Commercial	$2.96
Rate for Payer: Group Health Inc Medicare	$2.07
Rate for Payer: Hamaspik Choice Inc Medicaid	$2.96
Rate for Payer: Hamaspik Choice Inc Medicare	$2.96
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$3.85

DULOXETINE HCL 30 MG PO CPEP [39276]

Facility

$1.72

Service Code	NDC 00904704461
Hospital Charge Code	00904704461
Hospital Revenue Code	250
Min. Negotiated Rate	$0.60
Max. Negotiated Rate	$1.38
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$0.95
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$0.86
Rate for Payer: Aetna Government	$0.86
Rate for Payer: Brighton Health Commercial	$1.29
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1.38
Rate for Payer: Cigna LocalPlus Benefit Plan	$1.17
Rate for Payer: Group Health Inc Commercial	$0.86
Rate for Payer: Group Health Inc Medicare	$0.60
Rate for Payer: Hamaspik Choice Inc Medicaid	$0.86
Rate for Payer: Hamaspik Choice Inc Medicare	$0.86
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1.12

DULOXETINE HCL 60 MG PO CPEP [39277]

Facility

$7.85

Service Code	NDC 68180029606
Hospital Charge Code	68180029606
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 60 MG PO CPEP [39277]

Facility

$7.85

Service Code	NDC 57237001930
Hospital Charge Code	57237001930
Hospital Revenue Code	250
Min. Negotiated Rate	$2.75
Max. Negotiated Rate	$6.28
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.32
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.93
Rate for Payer: Aetna Government	$3.93
Rate for Payer: Brighton Health Commercial	$5.89
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.28
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.34
Rate for Payer: Group Health Inc Commercial	$3.93
Rate for Payer: Group Health Inc Medicare	$2.75
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.93
Rate for Payer: Hamaspik Choice Inc Medicare	$3.93
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 60 MG PO CPEP [39277]

Facility

$7.84

Service Code	NDC 43547038103
Hospital Charge Code	43547038103
Hospital Revenue Code	250
Min. Negotiated Rate	$2.74
Max. Negotiated Rate	$6.27
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.31
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.92
Rate for Payer: Aetna Government	$3.92
Rate for Payer: Brighton Health Commercial	$5.88
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.27
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.33
Rate for Payer: Group Health Inc Commercial	$3.92
Rate for Payer: Group Health Inc Medicare	$2.74
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.92
Rate for Payer: Hamaspik Choice Inc Medicare	$3.92
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.10

DULOXETINE HCL 60 MG PO CPEP [39277]

Facility

$7.70

Service Code	NDC 68084069201
Hospital Charge Code	68084069201
Hospital Revenue Code	250
Min. Negotiated Rate	$2.70
Max. Negotiated Rate	$6.16
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$4.24
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$3.85
Rate for Payer: Aetna Government	$3.85
Rate for Payer: Brighton Health Commercial	$5.78
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$6.16
Rate for Payer: Cigna LocalPlus Benefit Plan	$5.24
Rate for Payer: Group Health Inc Commercial	$3.85
Rate for Payer: Group Health Inc Medicare	$2.70
Rate for Payer: Hamaspik Choice Inc Medicaid	$3.85
Rate for Payer: Hamaspik Choice Inc Medicare	$3.85
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$5.00

DUODERM 4

Facility

$9.92

Hospital Charge Code	40204865
Hospital Revenue Code	270
Min. Negotiated Rate	$3.47
Max. Negotiated Rate	$7.94
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$5.46
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$4.96
Rate for Payer: Aetna Government	$4.96
Rate for Payer: Brighton Health Commercial	$7.44
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$7.94
Rate for Payer: Cigna LocalPlus Benefit Plan	$6.75
Rate for Payer: Group Health Inc Commercial	$4.96
Rate for Payer: Group Health Inc Medicare	$3.47
Rate for Payer: Hamaspik Choice Inc Medicaid	$4.96
Rate for Payer: Hamaspik Choice Inc Medicare	$4.96

DUODERM 6

Facility

$32.60

Hospital Charge Code	40204870
Hospital Revenue Code	270
Min. Negotiated Rate	$11.41
Max. Negotiated Rate	$26.08
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$17.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$16.30
Rate for Payer: Aetna Government	$16.30
Rate for Payer: Brighton Health Commercial	$24.45
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$26.08
Rate for Payer: Cigna LocalPlus Benefit Plan	$22.17
Rate for Payer: Group Health Inc Commercial	$16.30
Rate for Payer: Group Health Inc Medicare	$11.41
Rate for Payer: Hamaspik Choice Inc Medicaid	$16.30
Rate for Payer: Hamaspik Choice Inc Medicare	$16.30

DUPILUMAB 200 MG/1.14ML SC SOPN [180722]

Facility

$2,001.68

Service Code	NDC 00024591902
Hospital Charge Code	00024591902
Hospital Revenue Code	250
Min. Negotiated Rate	$700.59
Max. Negotiated Rate	$1,601.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,000.84
Rate for Payer: Aetna Government	$1,000.84
Rate for Payer: Brighton Health Commercial	$1,501.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,601.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,361.15
Rate for Payer: Group Health Inc Commercial	$1,000.84
Rate for Payer: Group Health Inc Medicare	$700.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,301.09

DUPILUMAB 200 MG/1.14ML SC SOSY [168916]

Facility

$2,001.68

Service Code	NDC 00024591801
Hospital Charge Code	00024591801
Hospital Revenue Code	250
Min. Negotiated Rate	$700.59
Max. Negotiated Rate	$1,601.35
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$1,100.93
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$1,000.84
Rate for Payer: Aetna Government	$1,000.84
Rate for Payer: Brighton Health Commercial	$1,501.26
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$1,601.35
Rate for Payer: Cigna LocalPlus Benefit Plan	$1,361.15
Rate for Payer: Group Health Inc Commercial	$1,000.84
Rate for Payer: Group Health Inc Medicare	$700.59
Rate for Payer: Hamaspik Choice Inc Medicaid	$1,000.84
Rate for Payer: Hamaspik Choice Inc Medicare	$1,000.84
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$1,301.09

DUPILUMAB 300 MG/2ML SC SOPN [173649]

Facility

$1,140.96

Service Code	NDC 00024591502
Hospital Charge Code	00024591502
Hospital Revenue Code	250
Min. Negotiated Rate	$399.34
Max. Negotiated Rate	$912.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$570.48
Rate for Payer: Aetna Government	$570.48
Rate for Payer: Brighton Health Commercial	$855.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$912.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$775.85
Rate for Payer: Group Health Inc Commercial	$570.48
Rate for Payer: Group Health Inc Medicare	$399.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.48
Rate for Payer: Hamaspik Choice Inc Medicare	$570.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$741.62

DUPILUMAB 300 MG/2ML SC SOSY [137895]

Facility

$1,140.96

Service Code	NDC 00024591401
Hospital Charge Code	00024591401
Hospital Revenue Code	250
Min. Negotiated Rate	$399.34
Max. Negotiated Rate	$912.77
Rate for Payer: 1199SEIU National Benefit Fund Commercial	$627.53
Rate for Payer: Aetna Gatekeeper/Non-Gatekeeper	$570.48
Rate for Payer: Aetna Government	$570.48
Rate for Payer: Brighton Health Commercial	$855.72
Rate for Payer: Cigna HMO/Network Benefit Plan/Open Access	$912.77
Rate for Payer: Cigna LocalPlus Benefit Plan	$775.85
Rate for Payer: Group Health Inc Commercial	$570.48
Rate for Payer: Group Health Inc Medicare	$399.34
Rate for Payer: Hamaspik Choice Inc Medicaid	$570.48
Rate for Payer: Hamaspik Choice Inc Medicare	$570.48
Rate for Payer: VNS Choice FIDA/MLTC Plus/Medicaid Advantage/Medicare Advantage/Special Needs Dual	$741.62

Know your out-of-pocket cost for care.

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