go back

Gum Tissue Graft From Own Mouth, First Site

Indiana 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 $4,786 · 10th–90th $550$6,3100%20%10th90th$4,786Professionalmedian $355 · 10th–90th $257$8130%10%10th90th$355$500.0$1.0K$2.0K$5.0K

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
$257.04
Median
$257.04
Typical High
$3,311.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$302.00
Typical High
$588.84
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$4,786.30
Typical High
$6,309.57
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$602.56
Typical High
$870.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$331.13
Typical High
$371.54