| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Cigna
| Professional | $264.66 | $264.66 | $317.08 | |
Molina
| Professional | $60.00 | $306.31 | $1,887.44 |
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 | |
Molina
| Professional | $60.00 | $306.31 | $1,887.44 |