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Arizona 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
$46.87 / $46.87 / $46.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.08 / $52.62 / $68.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.39 / $53.39 / $73.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.87 / $64.04 / $101.38
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.45 / $367.45 / $367.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.00 / $132.00 / $176.00