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 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
$194-270
99213
Re-evaluation
$157
70355
Panoramic Radiograph
$264
70486
Cone Beam CT of the maxillofacial area
$672
99152
IV sedation 1st 15 minutes
$386
99153
IV sedation each additional 15 minutes
$370
96374
Therapeutic drug signal administration
$133
41899
Removal of tooth
$410-1086
40808
Soft tissue biopsy
$953
20240
Hard tissue biopsy
$1969
21248
Placement of Dental Implant
$3774-4019
21210
Bone Graft to the Maxilla
21215
Bone Graft to the Mandible
41899
Guided Tissue Regeneration with Resorbable Membrane
$871
31299
Sinus Lift
$3762
41874
Alveoloplasty
$763-947
21031
Removal of Mandibular Torus
$2518

www.dhss.alaska.gov