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Gum Tissue Graft From Own Mouth, First Site

New Hampshire 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.

Professionalmedian $741 · 10th–90th $468$1,5140%10%10th90th$741$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
Professional
Modifier
Global
Typical Low
$562.34
Median
$562.34
Typical High
$575.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$562.34
Typical High
$794.33
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$660.69
Median
$1,096.48
Typical High
$1,698.24