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 | $4,500.00 | $4,500.00 | $5,519.00 | |
Aetna
| Professional | $4,500.00 | $4,500.00 | $4,500.00 | |
Molina
| Professional | $30.00 | $30.00 | $78.00 | |
United
| Facility | $1,800.00 | $62,445.00 | $76,459.00 |