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
$183-254
99213
Re-evaluation
$148
70355
Panoramic Radiograph
$249
70486
Cone Beam CT of the maxillofacial area
$633
99152
IV sedation 1st 15 minutes
$364
99152
IV sedation each additional 15 minutes
$327
96374
Therapeutic drug signal administration
$125
41899
Removal of tooth
$386-1023
40808
Soft tissue biopsy
$898
20240
Hard tissue biopsy
$1856
21248
Placement of Dental Implant
$3557-3788
21210
Bone Graft to the Maxilla
21215
Bone Graft to the Mandible
41899
Guided Tissue Regeneration with Resorbable Membrane
$821
31299
Sinus Lift
$3462-3546
41874
Alveoloplasty
$719-892
21031
Removal of Mandibular Torus
$2374

www.dhss.alaska.gov