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
Polivy
Low
$72
Average
$10.0k
Median
$8.1k
High
$36.6k
Each payer's average rate across its hospitals, under the methodology and billing class chosen below.
61 payers; the 90th percentile is 167.2× the 10th. Each bar is a price range and its height is how many payers fall in it. Hover a bar, or a row in the ladder, for details.
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| # | ||||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Humana fee schedule · outpatient · +20 other terms | 361 | $137 | $3.4k | $13.1k | 382% | 120 | $0 – $84.0k |
| 2 | Blue Cross Blue Shield fee schedule · outpatient · +27 other terms | 380 | $206 | $2.0k | $10.9k | 556% | 19–64 | $0 – $193.7k |
| 3 | Anthem fee schedule · outpatient · +24 other terms | 151 | $196 | $1.3k | $6.5k | 496% | 6–60 | $104 – $74.1k |
| 4 | UnitedHealthcare fee schedule · outpatient · +26 other terms | 653 | $214 | $1.3k | $6.6k | 495% | 2–20 | $0 – $99.9k |
| 5 | Aetna fee schedule · outpatient · +25 other terms | 431 | $157 | $3.9k | $18.6k | 476% | — | $1 – $254.9k |
| 6 | Cigna fee schedule · outpatient · +23 other terms | 375 | $199 | $2.8k | $11.1k | 395% | — | $118 – $90.4k |
| 7 | Molina fee schedule · outpatient · +22 other terms | 143 | $205 | $1.8k | $4.9k | 280% | — | $1 – $32.5k |
| 8 | WellCare fee schedule · outpatient · +16 other terms | 141 | $139 | $767 | $3.6k | 469% | — | $125 – $28.8k |
| 9 | Caresource fee schedule · outpatient · +17 other terms | 91 | $158 | $693 | $4.1k | 585% | — | $1 – $57.6k |
| 10 | Kaiser fee schedule · outpatient · +20 other terms | 75 | $206 | $2.6k | $8.6k | 335% | — | $109 – $56.9k |
| 11 | Ambetter facility · fee schedule · outpatient · +15 other terms | 73 | $247 | $1.9k | $7.2k | 385% | — | $133 – $43.2k |
| 12 | Devoted fee schedule · outpatient · +12 other terms | 63 | $137 | $447 | $2.2k | 499% | — | $124 – $19.1k |
| 13 | MultiPlan fee schedule · outpatient · +14 other terms | 58 | $28.8k | $29.0k | $34.6k | 119% | — | $0 – $96.9k |
| 14 | Highmark facility · fee schedule · outpatient · +16 other terms | 57 | $150 | $180 | $96 | 53% | — | $42 – $622 |
| 15 | Optum facility · fee schedule · outpatient · +20 other terms | 40 | $137 | $2.5k | $6.9k | 281% | — | $109 – $27.8k |
| 16 | Amerihealth Caritas facility · fee schedule · outpatient · +14 other terms | 39 | $142 | $1.7k | $6.1k | 370% | — | $134 – $43.2k |
| 17 | Medica fee schedule · outpatient · +18 other terms | 39 | $1.9k | $2.7k | $11.8k | 432% | — | $0 – $86.7k |
| 18 | Oscar facility · fee schedule · outpatient · +17 other terms | 35 | $175 | $175 | $35 | 20% | — | $137 – $253 |
| 19 | Medicare fee schedule · outpatient · +13 other terms | 32 | $134 | $148 | $106 | 72% | — | $115 – $957 |
| 20 | Bcbs Tx fee schedule · outpatient · +3 other terms | 31 | $482 | $448 | $198 | 44% | — | $125 – $860 |
| 21 | Clover fee schedule · outpatient · +7 other terms | 29 | $147 | $231 | $246 | 106% | — | $129 – $957 |
| 22 | Baylor Scott White Health Plan facility · fee schedule · outpatient · +2 other terms | 27 | $160 | $160 | $33 | 21% | — | $130 – $226 |
| 23 | Carefirst facility · fee schedule · both · +7 other terms | 26 | $12.7k | $17.5k | $14.1k | 81% | — | $4.1k – $63.3k |
| 24 | Excellus facility · fee schedule · both · +10 other terms | 26 | $12.7k | $16.1k | $13.1k | 81% | — | $4.0k – $63.3k |
| 25 | Premera facility · fee schedule · both · +5 other terms | 26 | $12.7k | $17.5k | $14.1k | 80% | — | $4.1k – $63.3k |
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