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Gum Tissue Graft From Own Mouth, First Site

Arizona 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 $427 · 10th–90th $309$6760%10%20%10th90th$427Professionalmedian $347 · 10th–90th $302$4790%20%40%10th90th$347$500.0$1.0K$2.0K

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
Professional
Modifier
Global
Typical Low
$302.00
Median
$346.74
Typical High
$478.63
Medica
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$426.58
Typical High
$676.08
Medica
Setting
Professional
Modifier
Global
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83