go back

Alaska rates for HCPCS D4355

Full Mouth Debridement To Enable A Comprehensive Periodontal Evaluation And Diagnosis On A Subsequent Visit

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,322.60 / $8,322.60 / $8,322.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.28 / $59.35 / $81.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.31 / $73.31 / $73.31
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$54.75 / $81.42 / $113.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.84 / $91.20 / $91.20
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,495.87 / $3,495.87 / $3,495.87
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.00 / $255.00 / $261.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.30 / $81.42 / $116.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $255.00 / $2,250,000.00