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California 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
$62.98 / $68.52 / $68.52
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.28 / $57.60 / $73.09
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.96 / $82.50 / $101.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$984.70 / $1,395.76 / $2,337.67
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.80 / $111.00 / $242.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.31 / $73.31 / $73.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.26 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$101.38 / $885.11 / $885.11
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$367.45 / $367.45 / $479.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $60.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.72 / $72.86 / $100.66
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.93 / $2,250,000.00 / $2,400,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.00 / $129.00 / $161.00