APC 9331

Polatuzumab vedotin injection

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.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Inj, polatuzumab vedotin 1mg

Payers reporting APC 9331

Payer pricing summary

Low

$71

Average

$668

Median

$144

High

$7.9k

Payer rate distribution

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#
1	Excellus case rate · outpatient	4	$187	$191	$70	37%	46	$137 – $307
2	UnitedHealthcare fee schedule · outpatient · +3 other terms	174	$138	$139	$3	2%	—	$124 – $146
3	Humana fee schedule · outpatient · +4 other terms	161	$137	$143	$39	27%	—	$124 – $547
4	Aetna fee schedule · outpatient · +4 other terms	155	$138	$142	$16	11%	—	$124 – $233
5	WellCare fee schedule · outpatient · +2 other terms	131	$141	$144	$6	4%	—	$133 – $181
6	Blue Cross Blue Shield fee schedule · outpatient · +4 other terms	126	$140	$139	$5	4%	—	$130 – $195
7	Devoted fee schedule · outpatient · +1 other terms	122	$137	$137	$2	1%	—	$137 – $144
8	Cigna Healthspring fee schedule · outpatient · +1 other terms	110	$142	$141	$4	3%	—	$137 – $155
9	Molina fee schedule · outpatient · +3 other terms	69	$201	$197	$75	38%	—	$133 – $358
10	Superior Healthplan fee schedule · outpatient	40	$144	$144	$2	1%	—	$144 – $151
11	Anthem fee schedule · outpatient · +1 other terms	31	$137	$137	$3	2%	—	$133 – $144
12	Oscar fee schedule · outpatient · +2 other terms	27	$134	$149	$30	20%	—	$134 – $233
13	Medicare facility · fee schedule · outpatient · +2 other terms	18	$137	$774	$3.2k	420%	—	$137 – $20.1k
14	Amerihealth Caritas fee schedule · outpatient · +1 other terms	17	$164	$164	$0	0%	—	$164 – $164
15	Cigna fee schedule · outpatient · +2 other terms	16	$140	$140	$7	5%	—	$133 – $159
16	Clover fee schedule · outpatient · +2 other terms	15	$144	$144	$2	1%	—	$144 – $151
17	Kaiser fee schedule · outpatient · +2 other terms	15	$140	$139	$1	1%	—	$136 – $140
18	Ambetter case rate · outpatient · +3 other terms	12	$246	$268	$26	10%	—	$246 – $298
19	Optum fee schedule · outpatient · +1 other terms	8	$140	$208	$99	48%	—	$137 – $359
20	Highmark case rate · outpatient · +2 other terms	5	$137	$185	$65	35%	—	$137 – $300
21	Medica facility · fee schedule · outpatient	5	$142	$143	$1	0%	—	$142 – $144
22	Tricare facility · fee schedule · outpatient	5	$137	$137	—	—	—	$137 – $137
23	Bcbs Nj facility · other · outpatient	3	$137	$137	—	—	—	$137 – $137
24	Sanford Health Plan case rate · outpatient	3	$197	$199	$20	10%	—	$165 – $227
25	Aetna Better Health facility · case rate · outpatient	1	$105	$105	$34	32%	—	$71 – $139

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