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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 October 2026.

How much rates vary

Facilitymedian $447 · 10th to 90th $339 to $3,715Professionalmedian $309 · 10th to 90th $309 to $2,399
$500$1K$2Kfacility $447professional $309

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$309.03
Median
$309.03
Typical High
$331.13
Medica
Setting
Facility
Modifier
None
Typical Low
$338.84
Median
$446.68
Typical High
$3,715.35
Medica
Setting
Professional
Modifier
None
Typical Low
$2,398.83
Median
$2,398.83
Typical High
$2,398.83