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
$34
Average
$4.8k
Median
$2.0k
High
$27.2k
Each hospital's average Aetna Better Health rate, under the methodology and billing class chosen below.
73 hospitals; the 90th percentile is 101.4× 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.
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91 hospital rates
iThe hospitals that file a Aetna Better Health rate for this code, one row per hospital and set of terms (billing class, payment method, setting). Rates under different terms are never blended, so the terms are shown under each hospital’s name. Figures are the hospital’s averages across its plans.| # | Plans | |||||||
|---|---|---|---|---|---|---|---|---|
| 1 | Appalachian Regional Healthcare, Inc. Hazard, KY percent of total billed charges · outpatientfrom % of charges | 1 | $26.4k | $26.4k | — | — | — | $26.4k – $26.4k |
| 2 | Appalachian Regional Healthcare, Inc. Harlan, KY percent of total billed charges · outpatientfrom % of charges | 1 | $11.4k | $11.4k | $7.4k | 65% | — | $4.0k – $18.8k |
| 3 | BELTON REGIONAL MEDICAL CENTER Kansas City, MO fee schedule · outpatient | 1 | $142 | $142 | — | — | — | $142 – $142 |
| 4 | BRFHH MONROE, LLC Monroe, LA other · outpatient | 1 | $6.3k | $6.3k | $4.1k | 65% | — | $2.2k – $10.4k |
| 5 | Baptist Medical Center of Nassau, INC Yulee, FL facility · case rate · outpatient | 2 | $5.6k | $5.6k | — | — | — | $5.6k – $5.6k |
| 6 | Baptist Medical Center of the Beaches, INC Beach, FL facility · case rate · outpatient | 2 | $5.6k | $5.6k | — | — | — | $5.6k – $5.6k |
| 7 | Capital Health System Inc Trenton, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 8 | Capital Health System Inc Browns Mills, NJ percent of total billed charges · outpatientfrom % of charges | 1 | $34 | $34 | — | — | — | $34 – $34 |
| 9 | Carle BroMenn Medical Center Normal, IL fee schedule · inpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 10 | Carle BroMenn Medical Center Normal, IL fee schedule · outpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 11 | Carle Eureka Hospital Eureka, IL fee schedule · inpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 12 | Carle Eureka Hospital Eureka, IL fee schedule · outpatient | 1 | $128 | $128 | — | — | — | $128 – $128 |
| 13 | CentraState Medical Center Freehold Township, NJ percent of total billed charges · bothfrom % of charges | 1 | $2.0k | $2.0k | — | — | — | $2.0k – $2.0k |
| 14 | Charleston Area Medical Center Charleston, WV percent of total billed charges · bothfrom % of charges | 1 | $7.2k | $7.2k | $4.6k | 65% | — | $2.5k – $11.8k |
| 15 | Children's Hospital of Philadelphia, The Philadelphia, PA percent of total billed charges · bothfrom % of charges | 1 | $6.6k | $6.6k | — | — | — | $6.6k – $6.6k |
| 16 | Deaconess Hospital, Inc Newburgh, IN facility · percent of total billed charges · outpatientfrom % of charges | 1 | $7.7k | $7.7k | $4.9k | 64% | — | $2.8k – $12.7k |
| 17 | Deaconess Illinois Crossroads Inc Mount Vernon, IL facility · case rate · outpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 18 | Deaconess Regional Healthcare Services Illinois Inc Marion, IL facility · case rate · outpatient | 1 | $139 | $139 | — | — | — | $139 – $139 |
| 19 | FAIRVIEW PARK HOSPITAL DUBLIN, GA fee schedule · outpatient | 1 | $146 | $146 | — | — | — | $146 – $146 |
| 20 | HSA CGH LLC Coral Gables, FL facility · fee schedule · outpatient | 1 | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 21 | HSA PGH LLC Hialeah, FL facility · fee schedule · outpatient | 1 | $4.4k | $4.4k | — | — | — | $4.4k – $4.4k |
| 22 | Henry Ford Health System West Bloomfield, MI facility · fee schedule · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 23 | Henry Ford Health System Plymouth, MI facility · fee schedule · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 24 | Henry Ford Macomb Hospital Corporation Clinton Twp, MI facility · fee schedule · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
| 25 | Henry Ford Wyandotte Hospital Brownstown Charter Twp., MI facility · fee schedule · outpatient | 1 | $73 | $73 | — | — | — | $73 – $73 |
← Payers reporting HCPCS J9309 · Snapshot 20261111T120946Z-9134e7f7