| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
HMSA
| Professional | QZ | $3.72 | $4.18 | $4.38 |
Anes Hrt Pericardial Sac& Grt Vesls W/O Pmp Oxt
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
HMSA
| Professional | QZ | $3.72 | $4.18 | $4.38 |