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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
$46.87 / $56.49 / $68.52
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.00 / $90.00 / $90.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.31 / $73.31 / $73.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47.81 / $79.26 / $116.38
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.34 / $94.36 / $2,400,000.00