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Mitomycin Pyelocalyceal Instillation (Jelmyto)

Tennessee rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Rates data updated July 2026.

How much rates vary

Facilitymedian $1,380 · 10th to 90th $1,380 to $1,380Professionalmedian $1,445 · 10th to 90th $282 to $1,445
$500$1Kfacility $1,380professional $1,445

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
$269.15
Median
$316.23
Typical High
$363.08
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44