Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Premera BCBS Facility/Professional Facility Modifier Low / Median / High Price $3,495.87 / $3,495.87 / $3,495.87	Facility		$3,495.87	$3,495.87	$3,495.87
Premera BCBS Facility/Professional Professional Modifier Low / Median / High Price $3,029.50 / $3,029.50 / $3,102.50	Professional		$3,029.50	$3,029.50	$3,102.50
Providence Facility/Professional Facility Modifier Low / Median / High Price $3,495.87 / $7,300.00 / $12,045.00	Facility		$3,495.87	$7,300.00	$12,045.00
Providence Facility/Professional Professional Modifier Low / Median / High Price $3,650.00 / $4,380.00 / $4,562.50	Professional		$3,650.00	$4,380.00	$4,562.50