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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 July 2026.

Facilitymedian $339 · 10th–90th $302$4070%20%40%10th90th$339Professionalmedian $200 · 10th–90th $100$3470%20%10th90th$200$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$338.84
Typical High
$407.38
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$199.53
Typical High
$346.74
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$39.81