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 Active-Duty Dependents
                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
99201
Consultation Visit
$155-215
99213
Re-evaluation
$125
70355
Panoramic Radiograph
$210
70486
Cone Beam CT of the maxillofacial area
$530
99152
IV sedation 1st 15 minutes
$300
99152
IV sedation each additional 15 minutes
$275
99513
Therapeutic drug signal administration
$105
96374
Removal of tooth
$315-860
41899
Soft tissue biopsy
$755
40808
Hard tissue biopsy
$1560
21248
Placement of Dental Implant
$2990-3185
21210
Bone Graft to the Maxilla
$830-1805
21215
Bone Graft to the Mandible
$830-1805
41899
Guided Tissue Regeneration with Resorbable Membrane
$690
31299
Sinus Lift
$2980
41874
Alveoloplasty
$605-750
21031
Removal of Mandibular Torus
$1995

www.dhss.alaska.gov