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Gum Tissue Graft From Own Mouth, First Site

Louisiana 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.

How much rates vary

Facilitymedian $407 · 10th to 90th $363 to $490Professionalmedian $417 · 10th to 90th $363 to $490
$500facility $407professional $417

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$363.08
Median
$407.38
Typical High
$489.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$407.38
Typical High
$489.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58