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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.

Facilitymedian $794 · 10th–90th $479$4,6770%10%10th90th$794Professionalmedian $479 · 10th–90th $309$8710%20%10th90th$479$50.0$200.0$1.0K$5.0K

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
$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