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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 October 2026.

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

$407

Typical negotiated rate. In Pennsylvania, October 2026.

Insurers have agreed to pay about $407 for this service. The price depends on where it is billed: about $407 from a physician practice, and about $813 from a hospital or other facility.

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.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$407$347 to $427
FacilityA hospital or hospital-owned outpatient department$813$661 to $1,072

How much rates vary

Facilitymedian $813 · 10th to 90th $617 to $1,698Professionalmedian $407 · 10th to 90th $309 to $427
$500$1K$2K$5K$10K$20K$50Kfacility $813professional $407

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$309.03
Median
$346.74
Typical High
$346.74
Aetna
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$346.74
Typical High
$346.74
Capital Blue Cross
Setting
Facility
Modifier
None
Typical Low
$4,265.80
Median
$5,011.87
Typical High
$79,432.82
Capital Blue Cross
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$407.38
Typical High
$426.58
Geisinger
Setting
Facility
Modifier
None
Typical Low
$645.65
Median
$794.33
Typical High
$1,412.54
Geisinger
Setting
Professional
Modifier
None
Typical Low
$426.58
Median
$426.58
Typical High
$426.58
Martin's Point
Setting
Facility
Modifier
None
Typical Low
$346.74
Median
$346.74
Typical High
$346.74
Martin's Point
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$346.74
Typical High
$346.74
Oscar Health
Setting
Professional
Modifier
None
Typical Low
$416.87
Median
$831.76
Typical High
$831.76

Where Pennsylvania 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.

Pennsylvania· 39th of 51

$407

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.