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Impacted Tooth Removal – Complex Bony Case

Washington rates for HCPCS D7241

Surgical removal of a tooth that is completely encased in jawbone, in a case that involves added surgical difficulty, for example the tooth's position near a nerve or sinus, an unusual root shape, or other complicating anatomy. It requires the same bone and gum access as a standard fully bony impaction, plus extra surgical steps to safely manage the complication. It is used only when those added factors are actually present, not for routine fully bony extractions.

Rates data updated July 2026.

Facilitymedian $661 · 10th–90th $347$17,7830%10%10th90th$661Professionalmedian $372 · 10th–90th $251$6460%20%10th90th$372$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$7,943.28
Typical High
$21,877.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$323.59
Typical High
$457.09
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$630.96
Typical High
$5,128.61
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$562.34
Typical High
$741.31
Molina
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$50.12
Typical High
$75.86
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$588.84
Typical High
$588.84
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86