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Montana rates for HCPCS J9340

Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)

Insurance Carrier
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$264.66 / $264.66 / $317.08
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.27 / $277.19 / $325.31
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.82 / $277.19 / $356.54