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Gum Tissue Graft From Own Mouth, First Site

Georgia 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 $347 · 10th–90th $347$3470%50%100%$347Professionalmedian $372 · 10th–90th $295$5500%20%40%10th90th$372$1.0$5.0$20.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$346.74
Typical High
$380.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$457.09
Typical High
$707.95
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$457.09