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Gum Tissue Graft From Own Mouth, First Site

Pennsylvania 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$6610%50%90th$347Professionalmedian $347 · 10th–90th $275$4790%20%10th90th$347$500.0$1.0K$2.0K$5.0K$10.0K$20.0K$50.0K

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
$275.42
Median
$346.74
Typical High
$478.63
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$407.38
Median
$426.58
Typical High
$426.58
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$660.69
Median
$660.69
Typical High
$660.69
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$331.13
Typical High
$436.52