Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $747.11 / $1,190.45 / $1,454.52	Professional		$747.11	$1,190.45	$1,454.52
Premera BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $133.77 / $213.15 / $273.42	Professional	26	$133.77	$213.15	$273.42
Premera BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $613.34 / $975.00 / $1,181.09	Professional	TC	$613.34	$975.00	$1,181.09
Providence Facility/Professional Professional Modifier Low / Median / High Price $383.08 / $1,065.00 / $1,472.60	Professional		$383.08	$1,065.00	$1,472.60
Providence Facility/Professional Professional Modifier 26 Low / Median / High Price $157.68 / $220.50 / $333.61	Professional	26	$157.68	$220.50	$333.61
Providence Facility/Professional Professional Modifier TC Low / Median / High Price $702.00 / $952.50 / $1,485.25	Professional	TC	$702.00	$952.50	$1,485.25