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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 July 2026.

Facilitymedian $407 · 10th–90th $302$8510%10%10th90th$407Professionalmedian $347 · 10th–90th $302$4570%20%10th90th$347$50.0$100.0$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$331.13
Typical High
$371.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$338.84
Typical High
$407.38
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$436.52
Typical High
$741.31
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$1,778.28
Typical High
$1,778.28
Molina
Setting
Professional
Modifier
Global
Typical Low
$30.20
Median
$30.20
Typical High
$30.20
Providence
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$436.52
Typical High
$741.31
Providence
Setting
Professional
Modifier
Global
Typical Low
$60.26
Median
$363.08
Typical High
$616.60
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$645.65