Percutaneous transluminal revascularization of chronic total occlusion, coronary artery, coronary artery branch, or coronary artery bypass graft, any combination of intracoronary stent, atherectomy and angioplasty; each additional coronary artery, coronary artery branch, or 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 | $192.05 | $205.77 | $418.05 | |
Molina
| Professional | $225.72 | $303.00 | $451.44 | |
Wellpoint
| Professional | $242.40 | $242.40 | $242.40 |