| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $318.17 | $318.17 | $318.17 | |
Molina
| Professional | $228.36 | $228.36 | $245.05 |
Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $318.17 | $318.17 | $318.17 | |
Molina
| Professional | $228.36 | $228.36 | $245.05 |