Gum Tissue Graft From Own Mouth, First Site

Rhode Island 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 rates vary

Professionalmedian $589 · 10th to 90th $589 to $589

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	Facility/Professional	Modifier	Typical Low	Median	Typical High
Aetna Setting Professional Modifier None Typical Low $588.84 Median $588.84 Typical High $588.84	Professional	None	$588.84	$588.84	$588.84