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Gum Tissue Graft From Own Mouth, First Site

Ohio 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 $347 · 10th–90th $347$3470%50%$347Professionalmedian $550 · 10th–90th $302$8710%10%10th90th$550$50.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
Global
Typical Low
$257.04
Median
$346.74
Typical High
$562.34
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$676.08
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$436.52
Median
$436.52
Typical High
$467.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$39.81
Median
$50.12
Typical High
$60.26
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$38.02
Median
$38.02
Typical High
$38.02
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$60.26
Typical High
$75.86