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Gum Tissue Graft From Own Mouth, First Site

New York 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 $302 · 10th–90th $234$3550%50%10th90th$302Professionalmedian $457 · 10th–90th $282$7590%10%10th90th$457$200.0$1.0K$5.0K$20.0K

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
$234.42
Median
$302.00
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$309.03
Typical High
$562.34
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$489.78
Typical High
$891.25
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$1,348.96
Typical High
$4,073.80
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$354.81
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$50,118.72
Median
$53,703.18
Typical High
$75,857.76
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$741.31
Typical High
$741.31
Univera
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$354.81
Typical High
$354.81
Univera
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$354.81
Typical High
$354.81