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Custom Gum Treatment Procedure

Illinois 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?

$372

Typical facility fee. In Illinois, October 2026.

Insurers have agreed to pay about $372 for this service. Most negotiated rates run $339 to $427.

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 $389 · 10th to 90th $302 to $525Professionalmedian $126 · 10th to 90th $40 to $347
$50$100$200$500facility $389professional $126

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

Rates by insurance carrier

Insurance Carrier
BCBS Illinois
Setting
Facility
Modifier
None
Typical Low
$302.00
Median
$389.05
Typical High
$524.81
Hally Health
Setting
Professional
Modifier
None
Typical Low
$100.00
Median
$125.89
Typical High
$346.74
Hally Health
Setting
Facility
Modifier
None
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
None
Typical Low
$39.81
Median
$39.81
Typical High
$39.81

Where Illinois sits

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.

Illinois· 10th of 36

$372

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.