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New York 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
$43.44 / $47.80 / $47.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.69 / $51.16 / $88.57
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.52 / $76.81 / $113.43
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.00 / $1,350.00 / $4,050.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.31 / $73.31 / $73.31
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.56 / $56.56 / $56.56
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.48 / $53.48 / $53.48
MVP Health Care
Facility/Professional
Facility
Modifier
Low / Median / High Price
$555.00 / $555.00 / $597.00
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.31 / $73.77 / $113.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $97.30 / $137.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.48 / $53.48 / $53.48
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.48 / $53.48 / $176.65