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Gum Tissue Graft From Own Mouth, First Site

Washington, DC 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 $331 · 10th–90th $331$3310%50%100%$331Professionalmedian $331 · 10th–90th $331$4790%50%90th$331$500.0

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
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$478.63
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$478.63
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$416.87
Typical High
$870.96