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Gum Tissue Graft From Own Mouth, First Site

North Dakota 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 $407 · 10th–90th $355$4070%50%10th$407Professionalmedian $589 · 10th–90th $407$6920%20%10th90th$589$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
$354.81
Median
$407.38
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$407.38
Typical High
$407.38
BCBS
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$588.84
Typical High
$707.95
Medica
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$467.74
Typical High
$1,230.27