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Gum Tissue Graft From Own Mouth, First Site

Tennessee 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 $3,715 · 10th–90th $339$3,7150%50%10th$3,715Professionalmedian $347 · 10th–90th $219$6920%20%10th90th$347$200.0$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
$218.78
Median
$338.84
Typical High
$338.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$218.78
Median
$338.84
Typical High
$398.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$691.83
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,715.35
Typical High
$3,715.35
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$3,162.28
Typical High
$3,162.28