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Gum Tissue Graft From Own Mouth, First Site

Washington 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.

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

$479

Typical negotiated rate. In Washington, July 2026.

Insurers have agreed to pay about $479 for this service. The price depends on where it is billed: about $479 from a physician practice, and about $794 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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 5 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$479$398 to $708
FacilityA hospital or hospital-owned outpatient department$794$603 to $1,072

How much rates vary

Facilitymedian $794 · 10th to 90th $479 to $4,677Professionalmedian $479 · 10th to 90th $309 to $871
$100$200$500$1K$2K$5K$10Kfacility $794professional $479

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$478.63
Typical High
$478.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$309.03
Median
$416.87
Typical High
$478.63
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$870.96
Typical High
$5,128.61
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$812.83
Typical High
$1,047.13
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$426.58
Median
$707.95
Typical High
$707.95
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$707.95
Median
$707.95
Typical High
$707.95

Where Washington sits

The same service costs 7.8 times more in Minnesota than in Nebraska. 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.

Washington· 16th of 51

$479

MN $2,138NE $275

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.