Fees

Individual fees may be higher or lower than provided in the following list. An estimate of the anticipated charges for your non-emergency care will be provided upon request. Please do not hesitate to ask for information. Alaska Oral Surgery Group is a contracted, in-network preferred provider for ONLY the following plan networks:
         • Federal Blue Cross
         • Premera Blue Cross of Alaska
         • Only the Following United Concordia Plans:
                o Active-Duty
                o Elite Plus
         • Medicaid
We Accept:
         • Logistics Health Incorporated (LHI) with appropriate referral and authorization
         • Veterans Affairs (VA) appropriate referral and authorization
You May Incur Out-of-Network Charges For Plans That We Are Not in Network With.

CPT
Description
Average Fee in US Dollars
99202
Consultation Visit
$170-236
99213
Re-evaluation
$137
70355
Panoramic Radiograph
$231
70486
Cone Beam CT of the maxillofacial area
$586
99152
IV sedation 1st 15 minutes
$330
99152
IV sedation each additional 15 minutes
$302
96374
Therapeutic drug signal administration
$115
41899
Removal of tooth
$357-946
41899
Soft tissue biopsy
$830
40808
Hard tissue biopsy
$1716
21248
Placement of Dental Implant
$3289-3503
21210
Bone Graft to the Maxilla
$896-2673
21215
Bone Graft to the Mandible
$896-3641
41899
Guided Tissue Regeneration with Resorbable Membrane
$759
31299
Sinus Lift
$3201
41874
Alveoloplasty
$665-825
21031
Removal of Mandibular Torus
$2195

www.dhss.alaska.gov