| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1,080.00 | $2,376.94 | $2,376.94 | |
Medica
| Professional | $221.75 | $260.81 | $2,184.00 |
Thiotepa 15 Mg (Special Coverage Instructions Apply. See Mcm: 2049)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $1,080.00 | $2,376.94 | $2,376.94 | |
Medica
| Professional | $221.75 | $260.81 | $2,184.00 |