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Gum Tissue Graft From Own Mouth, First Site

West 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.

How much rates vary

Facilitymedian $251 · 10th to 90th $251 to $251Professionalmedian $331 · 10th to 90th $251 to $479
$500facility $251professional $331

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$251.19
Typical High
$251.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$331.13
Typical High
$478.63