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Pedicle Gum Tissue Graft

South Carolina rates for HCPCS D4270

A gum surgery that moves healthy tissue from next to a receded area over to cover an exposed tooth root, keeping the tissue attached at one edge so it keeps its own blood supply. It is used to treat gum recession, protect the root from sensitivity and further wear, and improve the appearance of the gumline.

Rates data updated July 2026.

Facilitymedian $1,445 · 10th–90th $240$3,8900%10%10th90th$1,445Professionalmedian $251 · 10th–90th $240$3550%20%40%10th90th$251$100.0$200.0$500.0$1.0K$2.0K$5.0K

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

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$239.88
Median
$251.19
Typical High
$354.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$2,290.87
Typical High
$3,981.07
Medcost
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$371.54
Typical High
$588.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95