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Montana 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
$42.66 / $52.48 / $72.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $89.13 / $89.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.50 / $97.72 / $117.49
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $97.72 / $117.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $74.13 / $120.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $79.43 / $112.20