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Tennessee rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.22 / $313.50 / $361.95
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.75 / $1,376.10 / $1,376.10
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.80 / $400.80 / $400.80