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Gum Tissue Graft From Own Mouth, First Site

Nebraska 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 $2,291 · 10th–90th $275$4,4670%5%10%10th90th$2,291Professionalmedian $275 · 10th–90th $275$6920%50%90th$275$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Aetna
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,818.38
Typical High
$5,495.41
BCBS
Setting
Professional
Modifier
Global
Typical Low
$616.60
Median
$660.69
Typical High
$691.83
Medica
Setting
Facility
Modifier
Global
Typical Low
$275.42
Median
$478.63
Typical High
$3,715.35
Medica
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$2,398.83
Typical High
$2,398.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$645.65
Typical High
$1,000.00
Midlands
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$794.33
Typical High
$794.33