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Gum Tissue Graft From Own Mouth, First Site

Alaska 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 $525 · 10th–90th $331$7590%20%10th90th$525Professionalmedian $525 · 10th–90th $295$1,0960%20%40%10th90th$525$100.0$200.0$500.0$1.0K

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
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$524.81
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$524.81
Typical High
$758.58
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$575.44
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,096.48
Providence
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$524.81
Typical High
$758.58
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$575.44