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Gum Tissue Graft From Own Mouth, First Site

California 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 $372$3,3880%10%10th90th$525Professionalmedian $389 · 10th–90th $100$9770%10%10th90th$389$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
$436.52
Median
$436.52
Typical High
$467.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$346.74
Typical High
$467.74
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$478.63
Typical High
$562.34
Blue Shield
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$1,819.70
Typical High
$3,388.44
Blue Shield
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$1,071.52
Contra Costa Health
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$954.99
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$398.11
Typical High
$398.11
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,715.35
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$3,162.28
Typical High
$3,162.28
Providence
Setting
Facility
Modifier
Global
Typical Low
$338.84
Median
$501.19
Typical High
$707.95
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$389.05
Typical High
$524.81