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Gum Tissue Graft From Own Mouth, First Site

South Carolina 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 $1,445 · 10th–90th $324$3,8900%10%10th90th$1,445Professionalmedian $331 · 10th–90th $324$4370%20%40%10th90th$331$100.0$200.0$500.0$1.0K$2.0K$5.0K

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
$323.59
Median
$323.59
Typical High
$323.59
Aetna
Setting
Professional
Modifier
Global
Typical Low
$323.59
Median
$331.13
Typical High
$436.52
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$2,290.87
Typical High
$3,981.07
Medcost
Setting
Facility
Modifier
Global
Typical Low
$323.59
Median
$457.09
Typical High
$724.44
Molina
Setting
Professional
Modifier
Global
Typical Low
$54.95
Median
$54.95
Typical High
$54.95