Mitomycin Pyelocalyceal Instillation (Jelmyto)

Name: Negotiated commercial rates for Mitomycin Pyelocalyceal Instillation (Jelmyto) (HCPCS C9064), in Vermont
Creator: Tynbil
License: https://tynbil.com/terms

Vermont rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Rates data updated July 2026.

Rates by insurance carrier

Insurance Carrier	Facility/Professional	Modifier	Typical Low	Median	Typical High