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Wisconsin rates for HCPCS D4355

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

Facilitymedian $60 · 10th–90th $43–$1260%10%10th90th$60Professionalmedian $58 · 10th–90th $45–$1320%10%10th90th$58$50.0$100.0$200.0$500.0$1.0K

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
Facility
Modifier
Typical Low / Median / Typical High
$41.69 / $41.69 / $41.69
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$41.69 / $52.48 / $72.44
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $89.13 / $177.83
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $58.88 / $109.65
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$47.86 / $47.86 / $47.86
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$42.66 / $60.26 / $125.89
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $371.54 / $371.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $60.26 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $125.89 / $186.21
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$102.33 / $102.33 / $891.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $371.54 / $371.54
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $125.89 / $144.54