search again

Custom Gum Treatment Procedure

Nationwide rates for HCPCS D4999

A gum-related treatment that doesn't match one of the standard, commonly used periodontal procedures, so your dentist provides a detailed explanation of exactly what was done. It's used for unusual situations involving the gums or supporting structures of the teeth that need an individualized approach.

Rates data updated October 2026.

How much does Custom Gum Treatment Procedure cost?

$81.28

Typical negotiated rate. Nationwide, October 2026.

Insurers have agreed to pay about $81.28 for this service. The price depends on where it is billed: about $60.26 from a physician practice, and about $447 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 33 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$60.26$1.00 to $81.28
FacilityA hospital or hospital-owned outpatient department$447$245 to $1,549

How much rates vary

Facilitymedian $447 · 10th to 90th $224 to $7,943Professionalmedian $60 · 10th to 90th $1 to $759
$1$10$100$1K$10K$100Kfacility $447professional $60

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$1,288.25
AllWays Health Partners
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$309.03
Anthem BCBS
Setting
Facility
Modifier
None
Typical Low
$1.00
Median
$724.44
Typical High
$977.24
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$1.00
Median
$1.00
Typical High
$1.41
Asuris Northwest Health
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
AvMed
Setting
Facility
Modifier
None
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
BCBS Alabama
Setting
Facility
Modifier
None
Typical Low
$1,548.82
Median
$1,548.82
Typical High
$1,548.82
BCBS Idaho
Setting
Facility
Modifier
None
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
BCBS Idaho
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$302.00
Median
$389.05
Typical High
$524.81
BCBS Minnesota
Setting
Facility
Modifier
None
Typical Low
$309.03
Median
$575.44
Typical High
$1,659.59
BCBS Nebraska
Setting
Facility
Modifier
None
Typical Low
$2,089.30
Median
$2,754.23
Typical High
$5,623.41
BCBS North Carolina
Setting
Professional
Modifier
None
Typical Low
$67.61
Median
$67.61
Typical High
$67.61
BCBS Rhode Island
Setting
Facility
Modifier
None
Typical Low
$446.68
Median
$501.19
Typical High
$630.96
BCBS South Carolina
Setting
Facility
Modifier
None
Typical Low
$295.12
Median
$295.12
Typical High
$389.05
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$58,884.37
Median
$58,884.37
Typical High
$58,884.37
Cigna
Setting
Facility
Modifier
None
Typical Low
$19.50
Median
$19.50
Typical High
$19.50
Fallon Health
Setting
Facility
Modifier
None
Typical Low
$83.18
Median
$3,630.78
Typical High
$9,772.37
Florida Blue
Setting
Facility
Modifier
None
Typical Low
$229.09
Median
$229.09
Typical High
$72,443.60
Florida Blue
Setting
Professional
Modifier
None
Typical Low
$95.50
Median
$95.50
Typical High
$95.50
Hally Health
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$151.36
Typical High
$346.74
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Horizon BCBS
Setting
Facility
Modifier
None
Typical Low
$524.81
Median
$870.96
Typical High
$1,096.48
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$141.25
Median
$141.25
Typical High
$407.38
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$77.62
Typical High
$77.62
Mass General Brigham
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$194.98
Typical High
$309.03
Medica
Setting
Facility
Modifier
None
Typical Low
$89.13
Median
$89.13
Typical High
$100.00
Medica
Setting
Professional
Modifier
None
Typical Low
$77.62
Median
$97.72
Typical High
$97.72
Midlands
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Moda Health
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$60.26
Typical High
$60.26
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$44.67
Typical High
$60.26
Pacific Source
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$371.54
Physicians Health Plan of Northern Indiana
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$912.01
Typical High
$2,187.76
Providence
Setting
Facility
Modifier
None
Typical Low
$1,659,586.91
Median
$1,659,586.91
Typical High
$1,659,586.91
Providence
Setting
Professional
Modifier
None
Typical Low
$70.79
Median
$79.43
Typical High
$79.43
Select Health
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$4,265.80
Typical High
$5,011.87
Sentara
Setting
Facility
Modifier
None
Typical Low
$891.25
Median
$2,570.40
Typical High
$11,481.54
Sentara
Setting
Professional
Modifier
None
Typical Low
$7,413.10
Median
$10,232.93
Typical High
$11,481.54
Wellmark
Setting
Professional
Modifier
None
Typical Low
$64.57
Median
$81.28
Typical High
$81.28
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$758.58
Median
$758.58
Typical High
$758.58

What it costs in each state

The same service costs 69183.1 times more in Pennsylvania than in Colorado. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Touch or drag across the chart to see any state's rate.

PA $58,884CO $0.85

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.