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Gum Tissue Graft From Own Mouth, First Site

Colorado 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 $389 · 10th–90th $331$6030%20%40%10th90th$389Professionalmedian $331 · 10th–90th $295$3890%20%40%10th90th$331$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$331.13
Typical High
$354.81
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$389.05
Typical High
$457.09
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$478.63
Typical High
$645.65