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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 October 2026.

How much does Gum Tissue Graft From Own Mouth, First Site cost?

$692

Typical negotiated rate. In Virginia, October 2026.

Insurers have agreed to pay about $692 for this service. The price depends on where it is billed: about $741 from a physician practice, and about $575 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 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$741$457 to $813
FacilityA hospital or hospital-owned outpatient department$575$372 to $2,455

How much rates vary

Facilitymedian $575 · 10th to 90th $331 to $10,233Professionalmedian $741 · 10th to 90th $331 to $912
$500$1K$2K$5K$10Kfacility $575professional $741

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
$331.13
Median
$331.13
Typical High
$478.63
Aetna
Setting
Professional
Modifier
None
Typical Low
$331.13
Median
$478.63
Typical High
$478.63
Anthem BCBS
Setting
Professional
Modifier
None
Typical Low
$812.83
Median
$812.83
Typical High
$1,047.13
CareFirst
Setting
Professional
Modifier
None
Typical Low
$426.58
Median
$478.63
Typical High
$630.96
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$354.81
Median
$426.58
Typical High
$537.03
Medcost
Setting
Facility
Modifier
None
Typical Low
$478.63
Median
$575.44
Typical High
$724.44
Medcost
Setting
Professional
Modifier
None
Typical Low
$380.19
Median
$380.19
Typical High
$380.19
Sentara
Setting
Facility
Modifier
None
Typical Low
$316.23
Median
$831.76
Typical High
$10,232.93
Sentara
Setting
Professional
Modifier
None
Typical Low
$346.74
Median
$407.38
Typical High
$10,232.93

Where Virginia 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.

Virginia· 13th of 51

$692

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.