go back

Gum Tissue Graft From Own Mouth, First Site

Michigan 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 $331 · 10th–90th $331$3310%50%100%$331Professionalmedian $331 · 10th–90th $282$4680%50%10th90th$331$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
$331.13
Median
$331.13
Typical High
$331.13
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$331.13
Typical High
$371.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$331.13
Typical High
$331.13
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$331.13
Typical High
$446.68
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$467.74
Typical High
$467.74