| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $187.20 | $548.41 | $6,370.32 | |
Cigna
| Professional | $252.17 | $317.08 | $318.17 | |
Molina
| Professional | $252.40 | $252.40 | $252.40 |
Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
BCBS
| Facility | $187.20 | $548.41 | $6,370.32 | |
Cigna
| Professional | $252.17 | $317.08 | $318.17 | |
Molina
| Professional | $252.40 | $252.40 | $252.40 |