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Mitomycin Pyelocalyceal Instillation (Jelmyto)

Hawaii rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Rates data updated July 2026.

How much rates vary

Professionalmedian $339 · 10th to 90th $282 to $676
$500professional $339

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
$281.84
Median
$281.84
Typical High
$338.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$676.08
Typical High
$676.08