| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $269.86 | $283.22 | $339.33 | |
Kaiser Permanente
| Professional | $170.00 | $170.00 | $178.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |
Mitomycin pyelocalyceal instillation, 1 mg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $269.86 | $283.22 | $339.33 | |
Kaiser Permanente
| Professional | $170.00 | $170.00 | $178.00 | |
Pacific Source
| Facility | $79,999.20 | $79,999.20 | $79,999.20 |