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 | $7,799.00 | $22,776.00 | $67,098.00 | |
Aetna
| Professional | $9,062.00 | $9,062.00 | $9,062.00 | |
BCBS
| Facility | $16,036.13 | $29,116.06 | $47,447.41 | |
Cigna
| Facility | $21,239.00 | $32,000.00 | $58,466.00 | |
Molina
| Professional | $30.00 | $30.00 | $30.00 | |
United
| Facility | $225.00 | $1,679.00 | $24,011.00 |