go back

Gum Tissue Graft From Own Mouth, First Site

Illinois 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$2,3440%50%90th$295Professionalmedian $339 · 10th–90th $257$8710%20%10th90th$339$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
$295.12
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$331.13
Typical High
$562.34
BCBS
Setting
Facility
Modifier
Global
Typical Low
$933.25
Median
$2,238.72
Typical High
$2,691.53
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$199.53
Median
$1,348.96
Typical High
$1,737.80
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20