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Gum Tissue Graft From Own Mouth, First Site

Kentucky 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 $355 · 10th–90th $355$3550%50%100%$355Professionalmedian $550 · 10th–90th $347$6310%20%10th90th$550$50.0$100.0$200.0$500.0$1.0K

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
$354.81
Median
$354.81
Typical High
$354.81
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$354.81
Typical High
$363.08
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$630.96
Typical High
$630.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$371.54
Typical High
$371.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$44.67