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Gum Tissue Graft From Own Mouth, First Site

Nationwide rates for HCPCS D4273

A dental procedure that takes a small piece of the patient's own tissue and grafts it onto the gums at a tooth, implant, or toothless position. This charge covers the first site treated and includes the work at both the donor and recipient areas.

Rates data updated July 2026.

Facilitymedian $513 · 10th–90th $309$4,2660%20%10th90th$513Professionalmedian $398 · 10th–90th $302$1,2880%20%40%10th90th$398$0.5$5.0$50.0$500.0$5.0K$50.0K$500.0K

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
$295.12
Median
$346.74
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$346.74
Typical High
$478.63
BCBS
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$4,786.30
Typical High
$6,309.57
BCBS
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$549.54
Typical High
$912.01
Cigna
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$467.74
Typical High
$467.74
United
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$741.31
Typical High
$758.58