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Gum Tissue Graft From Own Mouth, First Site

Oregon 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 $708 · 10th–90th $427$7080%50%10th$708Professionalmedian $398 · 10th–90th $295$8130%50%10th90th$398$100.0$500.0$2.0K$10.0K$50.0K$200.0K$1.0M

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
Professional
Modifier
Global
Typical Low
$295.12
Median
$398.11
Typical High
$436.52
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$776.25
Typical High
$954.99
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$512.86
Typical High
$977.24
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$851.14
Typical High
$851.14
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$707.95
Typical High
$707.95
Providence
Setting
Facility
Modifier
Global
Typical Low
$354.81
Median
$512.86
Typical High
$977.24
Providence
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$79.43
Typical High
$1,071.52