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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 October 2026.

How much does Gum Tissue Graft From Own Mouth, First Site cost?

$550

Typical physician fee. In Ohio, October 2026.

Insurers have agreed to pay about $550 for this service. Most negotiated rates run $468 to $708.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 5 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $347 · 10th to 90th $339 to $1,413Professionalmedian $550 · 10th to 90th $347 to $871
$100$200$500$1Kfacility $347professional $550

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
$346.74
Median
$346.74
Typical High
$1,513.56
Aetna
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$1,288.25
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$537.03
Median
$549.54
Typical High
$870.96
Cigna
Setting
Professional
Modifier
None
Typical Low
$436.52
Median
$436.52
Typical High
$436.52
Molina
Setting
Professional
Modifier
None
Typical Low
$50.12
Median
$50.12
Typical High
$60.26
SummaCare
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$354.81
Typical High
$407.38

Where Ohio sits

The same service costs 9.5 times more in Texas than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Ohio· 28th of 51

$550

TX $2,399WV $251

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.