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Gum Tissue Graft From Own Mouth, First Site

South Dakota 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 $575 · 10th–90th $389$9550%20%10th90th$575Professionalmedian $355 · 10th–90th $347$7590%20%40%10th90th$355$500.0$1.0K$2.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$407.38
Median
$407.38
Typical High
$407.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$354.81
Medica
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$588.84
Typical High
$954.99
Medica
Setting
Professional
Modifier
Global
Typical Low
$338.84
Median
$645.65
Typical High
$2,398.83
Midlands
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$645.65
Typical High
$758.58
Midlands
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$758.58
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$812.83