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Gum Tissue Graft From Own Mouth, First Site

Arkansas 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.

How much rates vary

Facilitymedian $407 · 10th to 90th $407 to $407Professionalmedian $372 · 10th to 90th $324 to $407
facility $407professional $372

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. 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
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$371.54
Typical High
$407.38