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Gum Tissue Graft From Own Mouth, First Site

Texas 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?

$2,399

Typical negotiated rate. In Texas, October 2026.

Insurers have agreed to pay about $2,399 for this service. The price depends on where it is billed: about $2,399 from a physician practice, and about $380 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 8 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$2,399$457 to $3,236
FacilityA hospital or hospital-owned outpatient department$380$331 to $479

How much rates vary

Facilitymedian $380 · 10th to 90th $302 to $603Professionalmedian $2,399 · 10th to 90th $302 to $3,236
$500$1K$2Kfacility $380professional $2,399

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
$302.00
Median
$331.13
Typical High
$331.13
Aetna
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$323.59
Typical High
$371.54
Christus
Setting
Facility
Modifier
None
Typical Low
$812.83
Median
$812.83
Typical High
$812.83
Lucent Health
Setting
Professional
Modifier
None
Typical Low
$2,398.83
Median
$3,235.94
Typical High
$3,235.94
Moda Health
Setting
Facility
Modifier
None
Typical Low
$302.00
Median
$407.38
Typical High
$524.81
Moda Health
Setting
Professional
Modifier
None
Typical Low
$281.84
Median
$331.13
Typical High
$371.54
Molina
Setting
Professional
Modifier
None
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Providence
Setting
Facility
Modifier
None
Typical Low
$302.00
Median
$426.58
Typical High
$524.81
Providence
Setting
Professional
Modifier
None
Typical Low
$60.26
Median
$79.43
Typical High
$616.60
United
Setting
Professional
Modifier
None
Typical Low
$645.65
Median
$724.44
Typical High
$954.99
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$457.09
Median
$457.09
Typical High
$457.09

Where Texas 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.

Texas· 1st of 51

$2,399

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.