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 | $960.00 | $1,728.00 | $2,250.00 | |
BCBS
| Facility | $11,449.67 | $13,894.72 | $18,692.84 | |
Cigna
| Facility | $5,250.00 | $11,123.00 | $13,458.00 | |
United
| Facility | $250.00 | $951.00 | $16,883.00 |