go back

Montana rates for HCPCS D4355

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

Facilitymedian $95 · 10th–90th $50–$1230%20%10th90th$95Professionalmedian $56 · 10th–90th $46–$740%10%20%10th90th$56$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $53.70 / $72.44
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$95.50 / $97.72 / $3,235.94
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $97.72 / $3,235.94
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$47.86 / $74.13 / $120.23
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $79.43 / $112.20