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Massachusetts rates for HCPCS D4355

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

Facilitymedian $87 · 10th–90th $66–$1,7380%20%40%10th90th$87Professionalmedian $65 · 10th–90th $46–$2040%10%10th90th$65$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$87.10 / $87.10 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$42.66 / $52.48 / $87.10
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $891.25 / $2,344.23
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $147.91 / $371.54
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$60.26 / $75.86 / $89.13
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$66.07 / $66.07 / $89.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $158.49 / $229.09
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$66.07 / $891.25 / $2,344.23
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$69.18 / $147.91 / $371.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$34.67 / $87.10 / $134.90