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Gum Tissue Graft From Own Mouth, First Site

New Jersey 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 October 2026.

How much rates vary

Facilitymedian $4,266 · 10th to 90th $234 to $6,761Professionalmedian $447 · 10th to 90th $234 to $631
$500$1K$2K$5K$10Kfacility $4,266professional $447

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$1,288.25
Aetna
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$234.42
Typical High
$426.58
Horizon BCBS
Setting
Facility
Modifier
None
Typical Low
$3,162.28
Median
$5,248.07
Typical High
$7,244.36
Horizon BCBS
Setting
Professional
Modifier
None
Typical Low
$446.68
Median
$467.74
Typical High
$794.33