go back

Utah rates for HCPCS D4355

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

Facilitymedian $62 · 10th–90th $62–$620%50%100%$62Professionalmedian $56 · 10th–90th $45–$740%10%20%10th90th$56$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$61.66 / $61.66 / $61.66
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $52.48 / $72.44
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $79.43
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$100.00 / $104.71 / $104.71
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $77.62 / $81.28