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