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Custom Gum Treatment Procedure

Idaho 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 July 2026.

How much does Custom Gum Treatment Procedure cost?

$380

Typical facility fee. In Idaho, July 2026.

Insurers have agreed to pay about $380 for this service. Most negotiated rates run $30.20 to $380.

Few insurers publish rates for this combination, so treat this figure as a rough guide.

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 3 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $380 · 10th to 90th $380 to $603Professionalmedian $30 · 10th to 90th $30 to $380
$50$100$200$500facility $380professional $30

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
BCBS
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
BCBS
Setting
Professional
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$77.62
Select Health
Setting
Facility
Modifier
Global
Typical Low
$380.19
Median
$380.19
Typical High
$602.56

Where Idaho sits

The same service costs 3715352.3 times more in Florida than in Ohio. 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.

Idaho· 12th of 37

$380

FL $74,131OH $0.02

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.