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 | $7,943.28 | $38,018.94 | $67,608.30 | |
Aetna
| Professional | $9,120.11 | $9,120.11 | $9,120.11 | |
BCBS
| Facility | $15,488.17 | $26,915.35 | $48,977.88 | |
Cigna
| Facility | $16,982.44 | $30,902.95 | $61,659.50 | |
Molina
| Professional | $30.20 | $30.20 | $30.20 | |
United
| Facility | $380.19 | $1,737.80 | $26,302.68 |