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Gum Tissue Graft From Own Mouth, First Site

Maine 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 October 2026.

How much does Gum Tissue Graft From Own Mouth, First Site cost?

$562

Typical physician fee. In Maine, October 2026.

Insurers have agreed to pay about $562 for this service. Most negotiated rates run $457 to $646.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $562 · 10th to 90th $372 to $832
$500$1Kprofessional $562

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$457.09
Typical High
$575.44
Harvard Pilgrim
Setting
Professional
Modifier
None
Typical Low
$660.69
Median
$794.33
Typical High
$1,023.29
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$645.65
Median
$645.65
Typical High
$645.65

Where Maine sits

The same service costs 9.5 times more in Texas than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Maine· 25th of 51

$562

TX $2,399WV $251

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.