go back

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.

Facilitymedian $309 · 10th–90th $309$5620%50%90th$309Professionalmedian $316 · 10th–90th $309$2,3990%20%40%10th90th$316$500.0$2.0K$10.0K$50.0K$200.0K

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
$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