go back

Gum Tissue Graft From Own Mouth, First Site

Missouri 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 $427 · 10th–90th $363$8710%20%10th90th$427Professionalmedian $363 · 10th–90th $295$6030%10%10th90th$363$200.0$500.0$1.0K$2.0K

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
$363.08
Median
$426.58
Typical High
$426.58
Aetna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$346.74
Typical High
$426.58
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$467.74
Typical High
$676.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$630.96
Median
$691.83
Typical High
$691.83
Medica
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$501.19
Typical High
$1,318.26
Medica
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$2,398.83
Typical High
$2,398.83