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Gum Tissue Graft From Own Mouth, First Site

Massachusetts 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 $562 · 10th–90th $562$3,7150%20%40%90th$562Professionalmedian $661 · 10th–90th $309$1,4130%10%10th90th$661$100.0$500.0$2.0K$10.0K$50.0K

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
$562.34
Median
$562.34
Typical High
$562.34
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$416.87
Typical High
$588.84
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,737.80
Typical High
$3,715.35
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$741.31
Typical High
$2,398.83
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$83.18
Median
$4,897.79
Typical High
$9,772.37
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$501.19
Typical High
$588.84
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$562.34
Median
$912.01
Typical High
$1,445.44
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$1,737.80
Typical High
$3,715.35
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$478.63
Median
$741.31
Typical High
$2,398.83