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Gum Tissue Graft From Own Mouth, First Site

Iowa 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 $437 · 10th–90th $339$1,0960%20%10th90th$437Professionalmedian $355 · 10th–90th $275$1,0000%20%10th90th$355$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
$338.84
Median
$338.84
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$338.84
Typical High
$354.81
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,230.27
Typical High
$1,737.80
Medica
Setting
Facility
Modifier
Global
Typical Low
$416.87
Median
$660.69
Typical High
$1,288.25
Medica
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$691.83
Typical High
$2,398.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$645.65
Typical High
$870.96
Midlands
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$1,000.00
Typical High
$1,071.52
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$812.83
Typical High
$812.83