Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of intracoronary stent, atherectomy and angioplasty, including distal protection when performed; each additional branch subtended by the bypass graft (List separately in addition to code for primary procedure)
| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Florida Blue
| Facility | $13,312.00 | $24,073.00 | $46,234.00 | |
Florida Blue
| Professional | $160.22 | $171.67 | $348.77 | |
Molina
| Professional | $187.24 | $251.33 | $374.48 | |
Wellpoint
| Professional | $201.07 | $201.07 | $201.07 |