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Virginia 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
$50.39 / $74.97 / $74.97
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.20 / $53.48 / $74.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.50 / $82.50 / $117.29
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.00 / $107.00 / $208.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.31 / $73.31 / $73.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.98 / $66.23 / $109.54
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$50.39 / $67.02 / $114.18
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.00 / $101.57 / $130.87
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.59 / $67.92 / $101.29
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.59 / $67.92 / $101.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $77.00 / $130.00