| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $264.66 | $317.08 | $317.08 | |
Kaiser Permanente
| Professional | $259.95 | $705.87 | $1,141.00 |
Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $264.66 | $317.08 | $317.08 | |
Kaiser Permanente
| Professional | $259.95 | $705.87 | $1,141.00 |