go back

Indiana 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
$39.01 / $39.01 / $92.22
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.01 / $48.75 / $60.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.50 / $90.00 / $124.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$15,649.61 / $16,774.95 / $23,574.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.39 / $74.84 / $74.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.00 / $142.00 / $145.00