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Utah 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
$61.07 / $61.07 / $61.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.08 / $56.05 / $68.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $115.35