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Gum Tissue Graft From Own Mouth, First Site

North Carolina 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 $372 · 10th–90th $324$6760%20%40%10th90th$372Professionalmedian $457 · 10th–90th $331$8510%10%20%10th90th$457$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
$371.54
Median
$371.54
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$371.54
Typical High
$478.63
BCBS
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$831.76
Typical High
$1,023.29
Medcost
Setting
Facility
Modifier
Global
Typical Low
$316.23
Median
$389.05
Typical High
$691.83
United
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$691.83
Typical High
$758.58
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,715.35
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$3,162.28