| Insurance Carrier | Facility/Professional | Modifier | Low Price | Median Price | High Price |
|---|---|---|---|---|---|
Medica
| Facility | $316.23 | $2,754.23 | $25,118.86 | |
United
| Facility | $2,884.03 | $3,467.37 | $6,165.95 |
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 |
|---|---|---|---|---|---|
Medica
| Facility | $316.23 | $2,754.23 | $25,118.86 | |
United
| Facility | $2,884.03 | $3,467.37 | $6,165.95 |