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Gum Tissue Graft From Own Mouth, First Site

Oklahoma 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.

How much rates vary

Facilitymedian $309 · 10th to 90th $309 to $562Professionalmedian $316 · 10th to 90th $309 to $2,399
$1K$10K$100Kfacility $309professional $316

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$316.23
Medica
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$331.13
Typical High
$676.08
Medica
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$645.65
Typical High
$2,398.83