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Pedicle Gum Tissue Graft

South Dakota 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 October 2026.

How much does Pedicle Gum Tissue Graft cost?

$537

Typical negotiated rate. In South Dakota, October 2026.

Insurers have agreed to pay about $537 for this service. The price depends on where it is billed: about $537 from a physician practice, and about $437 from a hospital or other facility.

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 4 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$537$263 to $776
FacilityA hospital or hospital-owned outpatient department$437$372 to $437

How much rates vary

Facilitymedian $437 · 10th to 90th $324 to $891Professionalmedian $537 · 10th to 90th $257 to $776
$500$1Kfacility $437professional $537

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
Aetna
Setting
Facility
Modifier
None
Typical Low
$323.59
Median
$323.59
Typical High
$323.59
Aetna
Setting
Professional
Modifier
None
Typical Low
$257.04
Median
$257.04
Typical High
$263.03
Medica
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$436.52
Typical High
$537.03
Medica
Setting
Professional
Modifier
None
Typical Low
$251.19
Median
$1,819.70
Typical High
$1,819.70
Midlands
Setting
Professional
Modifier
None
Typical Low
$416.87
Median
$537.03
Typical High
$537.03
Midlands
Setting
Facility
Modifier
None
Typical Low
$891.25
Median
$891.25
Typical High
$1,071.52
Midlands
Setting
Professional
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Wellmark
Setting
Professional
Modifier
None
Typical Low
$776.25
Median
$776.25
Typical High
$776.25

Where South Dakota sits

The same service costs 9.5 times more in Texas than in New Jersey. 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.

South Dakota· 16th of 51

$537

TX $1,820NJ $191

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.