Percutaneous transluminal revascularization of or through coronary artery bypass graft (internal mammary, free arterial, venous), any combination of drug-eluting 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 |
|---|---|---|---|---|---|
Aetna
| Facility | $2,747.00 | $6,754.35 | $16,587.00 | |
Aetna
| Professional | $2,843.00 | $4,944.50 | $14,500.97 | |
BCBS
| Facility | $14,913.00 | $20,432.00 | $32,402.00 | |
BCBS
| Professional | $8.01 | $8.01 | $8.01 | |
Cigna
| Facility | $8,838.50 | $15,414.00 | $27,692.44 | |
Cigna
| Professional | $265.12 | $265.12 | $265.12 | |
United
| Facility | $464.00 | $1,641.00 | $29,001.00 | |
United
| Professional | $33,226.41 | $33,226.41 | $33,226.41 |
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