| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $116.58 | $159.50 | $194.30 | |
Providence
| Professional | $266.36 | $266.36 | $445.12 |
Introduction of mixture of saline and air for sonosalpingography to confirm occlusion of fallopian tubes, transcervical approach, including transvaginal ultrasound and pelvic ultrasound
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Pacific Source
| Facility | $116.58 | $159.50 | $194.30 | |
Providence
| Professional | $266.36 | $266.36 | $445.12 |