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Gum Tissue Graft From Own Mouth, First Site

Wyoming 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 rates vary

Facilitymedian $389 · 10th to 90th $389 to $389Professionalmedian $933 · 10th to 90th $389 to $933
$500$1Kfacility $389professional $933

Distribution of negotiated rates across all payers (price axis is log-scale). 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
None
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
Aetna
Setting
Professional
Modifier
None
Typical Low
$389.05
Median
$389.05
Typical High
$389.05
BCBS Wyoming
Setting
Professional
Modifier
None
Typical Low
$933.25
Median
$933.25
Typical High
$933.25
BCBS Wyoming
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$660.69
Median
$660.69
Typical High
$660.69