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Gum Tissue Graft From Own Mouth, First Site

Florida 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 $295 · 10th–90th $295$1,6220%50%90th$295Professionalmedian $347 · 10th–90th $295$4470%20%10th90th$347$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$295.12
Median
$295.12
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$354.81
Typical High
$436.52
AvMed
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$1,621.81
Typical High
$1,621.81
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$389.05
Typical High
$1,122.02
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$288.40
Typical High
$562.34
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$39.81
Typical High
$50.12
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$457.09