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Gum Tissue Graft From Own Mouth, First Site

Wisconsin 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 $398 · 10th–90th $282$7240%20%10th90th$398Professionalmedian $589 · 10th–90th $282$1,2880%10%10th90th$589$100.0$200.0$500.0$1.0K$2.0K$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$281.84
Typical High
$281.84
Aetna
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$331.13
Typical High
$354.81
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$707.95
Typical High
$1,318.26
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$398.11
Typical High
$707.95
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Medica
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$426.58
Typical High
$724.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$2,398.83
Typical High
$2,398.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$54.95
Typical High
$70.79
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$281.84
Median
$398.11
Typical High
$707.95
Prevea360
Setting
Professional
Modifier
Global
Typical Low
$316.23
Median
$316.23
Typical High
$316.23
Quartz
Setting
Professional
Modifier
Global
Typical Low
$489.78
Median
$891.25
Typical High
$1,230.27
Quartz
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$2,570.40
Typical High
$3,715.35
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,949.84
Median
$2,398.83
Typical High
$2,398.83
Security Health
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$478.63
Typical High
$524.81