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Gum Tissue Graft From Own Mouth, First Site

Minnesota 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 $4,169 · 10th–90th $355$10,9650%10%10th90th$4,169Professionalmedian $2,138 · 10th–90th $417$2,1380%50%10th$2,138$500.0$1.0K$2.0K$5.0K$10.0K$20.0K

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
$316.23
Median
$354.81
Typical High
$478.63
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$4,466.84
Typical High
$11,220.18
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$2,137.96
Typical High
$2,137.96
Medica
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$562.34
Typical High
$831.76
Medica
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83