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 | $33,847.00 | $36,230.00 | $51,666.00 | |
Aetna
| Professional | $2,843.00 | $2,843.00 | $2,843.00 | |
BCBS
| Facility | $0.95 | $1.00 | $11,250.14 | |
Medica
| Facility | $563.00 | $1,749.00 | $51,251.00 | |
United
| Facility | $563.00 | $1,749.00 | $54,326.00 |