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Gum Tissue Graft From Own Mouth, First Site

Mississippi 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 $257 · 10th–90th $257$3890%50%90th$257Professionalmedian $331 · 10th–90th $257$3980%20%10th90th$331$20.0$50.0$100.0$200.0$500.0

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
$257.04
Median
$257.04
Typical High
$389.05
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$331.13
Typical High
$398.11
BCBS
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
BCBS
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$831.76
Typical High
$831.76
Molina
Setting
Professional
Modifier
Global
Typical Low
$21.38
Median
$25.12
Typical High
$50.12