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Gum Tissue Graft From Own Mouth, First Site

Virginia 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 $479 · 10th–90th $331$10,0000%10%20%10th90th$479Professionalmedian $479 · 10th–90th $331$9120%10%20%10th90th$479$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$331.13
Median
$478.63
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$346.74
Typical High
$478.63
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$812.83
Typical High
$1,348.96
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$426.58
Median
$537.03
Typical High
$724.44
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$426.58
Typical High
$1,148.15
Medcost
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$489.78
Typical High
$794.33
Sentara
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$478.63
Typical High
$10,000.00
Sentara
Setting
Professional
Modifier
Global
Typical Low
$302.00
Median
$467.74
Typical High
$10,000.00