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Wisconsin rates for HCPCS C9064

Mitomycin pyelocalyceal instillation, 1 mg

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.96 / $636.62 / $910.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.19 / $283.22 / $339.33
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.10 / $1,376.10 / $1,376.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.80 / $400.80 / $400.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.40 / $58.40 / $58.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,376.10 / $1,376.10 / $1,376.10
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$400.80 / $400.80 / $400.80