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Gum Tissue Graft From Own Mouth, First Site

Idaho 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 $617 · 10th–90th $363$1,6980%10%10th90th$617Professionalmedian $398 · 10th–90th $363$8510%20%10th90th$398$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
Professional
Modifier
Global
Typical Low
$363.08
Median
$398.11
Typical High
$478.63
BCBS
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$776.25
Typical High
$1,698.24
BCBS
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$851.14
Typical High
$851.14
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$467.74
Typical High
$645.65
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Select Health
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,584.89
Typical High
$3,801.89