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Gum Tissue Graft From Own Mouth, First Site

New Mexico 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 $525 · 10th–90th $302$9770%5%10%10th90th$525Professionalmedian $302 · 10th–90th $302$3390%50%90th$302$100.0$200.0$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$338.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$70.79
Typical High
$85.11
Providence
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$524.81
Typical High
$977.24