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Idaho rates for HCPCS D4355

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.39 / $59.35 / $73.98
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
$54.40 / $61.07 / $94.71
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.96 / $132.96 / $132.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,000.00 / $3,900.00