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Mitomycin Pyelocalyceal Instillation (Jelmyto)

Arizona rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Rates data updated July 2026.

How much does Mitomycin Pyelocalyceal Instillation (Jelmyto) cost?

$324per mg

Typical physician fee. In Arizona, July 2026.

Insurers have agreed to pay about $324 for each mg of this drug. Most negotiated rates run $282 to $339.

Work out the cost of a dose

This drug is priced per mg. Enter the amount given to see what insurers have agreed to pay for it.

mg
In a doctor's office or clinic
$324

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $275 · 10th to 90th $275 to $1,380Professionalmedian $324 · 10th to 90th $282 to $398
$500$1Kfacility $275professional $324

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Cigna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$295.12
Typical High
$338.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$1,380.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
United
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$323.59
Typical High
$323.59

Where Arizona sits

The same service costs 45.7 times more in Tennessee than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Arizona· 15th of 42

$324

TN $1,380SC $30.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.