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Illinois rates for HCPCS D4355

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

Facilitymedian $832 · 10th–90th $100–$1,3180%20%10th90th$832Professionalmedian $52 · 10th–90th $45–$1860%10%20%10th90th$52$20.0$50.0$100.0$200.0$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $47.86
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $52.48 / $72.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$831.76 / $977.24 / $1,318.26
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $199.53 / $229.09
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $2,511.89
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $128.82 / $181.97