Unspecified periodontal procedure

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
API: message_batches
Reasoning effort: low
Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

UNSPECIFIED PERIODONTAL PROC

Payers reporting HCPCS D4999

Payer pricing summary

Low

Average

$749

Median

$380

High

$7.1k

Payer rate distribution

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#
1	Aetna fee schedule · outpatient · +7 other terms	224	$253	$306	$170	55%	—	$132 – $1.3k
2	UnitedHealthcare fee schedule · outpatient · +8 other terms	150	$248	$387	$470	122%	—	$211 – $6.8k
3	Humana fee schedule · outpatient · +8 other terms	142	$236	$250	$171	68%	—	$1 – $1.3k
4	Blue Cross Blue Shield fee schedule · outpatient · +6 other terms	129	$259	$419	$274	65%	—	$0 – $1.8k
5	Molina fee schedule · outpatient · +5 other terms	81	$278	$323	$112	35%	—	$173 – $641
6	Cigna fee schedule · outpatient · +5 other terms	80	$243	$312	$166	53%	—	$220 – $1.0k
7	WellCare facility · fee schedule · outpatient · +3 other terms	73	$255	$656	$2.5k	377%	—	$214 – $22k
8	Ambetter facility · fee schedule · outpatient · +1 other terms	48	$423	$458	$104	23%	—	$216 – $594
9	Anthem facility · fee schedule · outpatient · +5 other terms	45	$355	$535	$483	90%	—	$0 – $2.9k
10	Devoted fee schedule · outpatient · +1 other terms	43	$244	$241	$14	6%	—	$220 – $265
11	Oscar facility · fee schedule · outpatient · +2 other terms	26	$346	$646	$993	154%	—	$266 – $4.1k
12	Bcbs Tx fee schedule · outpatient	23	$228	$228	$6	3%	—	$218 – $239
13	Kaiser fee schedule · outpatient · +1 other terms	23	$508	$477	$220	46%	—	$263 – $1.0k
14	Optum fee schedule · outpatient · +4 other terms	22	$239	$370	$196	53%	—	$215 – $874
15	Clover fee schedule · outpatient · +1 other terms	21	$254	$249	$16	6%	—	$214 – $273
16	Regence facility · fee schedule · outpatient · +1 other terms	18	$249	$295	$136	46%	—	$215 – $760
17	Caresource facility · fee schedule · outpatient · +3 other terms	17	$363	$335	$95	28%	—	$218 – $472
18	MultiPlan fee schedule · outpatient · +4 other terms	14	$392	$392	—	—	—	$392 – $392
19	Highmark fee schedule · outpatient · +1 other terms	13	$296	$305	$107	35%	—	$104 – $567
20	Tricare facility · fee schedule · outpatient · +2 other terms	13	$229	$2.5k	$2.9k	115%	—	$221 – $6.1k
21	Bcbs Nj fee schedule · outpatient	12	$261	$550	$369	67%	—	$254 – $1.1k
22	Medical Mutual fee schedule · outpatient · +1 other terms	10	$636	$579	$198	34%	—	$206 – $995
23	Ucare facility · fee schedule · outpatient	10	$233	$236	$19	8%	—	$196 – $281
24	Healthpartners facility · fee schedule · outpatient · +1 other terms	8	$233	$287	$138	48%	—	$228 – $652
25	Medicare facility · fee schedule · outpatient · +1 other terms	8	$3.7k	$5.0k	$6.7k	135%	—	$231 – $22k

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