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Mitomycin Pyelocalyceal Instillation (Jelmyto)

Rhode Island rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Rates data updated July 2026.

How much rates vary

Facilitymedian $282 · 10th to 90th $282 to $302Professionalmedian $288 · 10th to 90th $288 to $288
facility $282professional $288

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
BCBS
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$288.40
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$338.84