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Mitomycin Pyelocalyceal Instillation (Jelmyto)

Wisconsin rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Rates data updated July 2026.

How much does Mitomycin Pyelocalyceal Instillation (Jelmyto) cost?

$339per mg

Typical negotiated rate. In Wisconsin, July 2026.

Insurers have agreed to pay about $339 for each mg of this drug. The price depends on where it is billed: about $302 from a physician practice, and about $646 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

Work out the cost of a dose

This drug is priced per mg. Enter the amount given to see what insurers have agreed to pay for it.

mg
In a doctor's office or clinic
$302
At a hospital outpatient department
$646

The same drug, in the same amount, costs 114% more at a hospital than at a doctor's office.

Drug cost only. Giving the drug, the visit itself and any monitoring are billed on their own codes. We do not publish dosing guidance: use the amount from your own prescription or treatment plan.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$302$302 to $339
FacilityA hospital or hospital-owned outpatient department$646$389 to $1,096

How much rates vary

Facilitymedian $646 · 10th to 90th $347 to $1,318Professionalmedian $302 · 10th to 90th $269 to $339
$500$1Kfacility $646professional $302

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
Facility
Modifier
Global
Typical Low
$346.74
Median
$645.65
Typical High
$1,096.48
Cigna
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$302.00
Typical High
$338.84
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$1,380.38
Typical High
$1,380.38
Medica
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$398.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$58.88
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,380.38
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,445.44
Typical High
$1,445.44

Where Wisconsin sits

The same service costs 45.7 times more in Tennessee than in South Carolina. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Wisconsin· 10th of 42

$339

TN $1,380SC $30.20

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.