| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $267.19 | $269.86 | $333.98 | |
Sanford Health Plan
| Professional | $272.54 | $272.54 | $272.54 |
Mitomycin pyelocalyceal instillation, 1 mg
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $267.19 | $269.86 | $333.98 | |
Sanford Health Plan
| Professional | $272.54 | $272.54 | $272.54 |