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Resource 1
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Non-Member
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YOU
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Member Fees
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U/C Fees
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$AVE
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| Schedule A |
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| I. Initial Diagnosis - Treatment Planning & Radiographic Procedures |
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| A. Initial Consultation and Comprehensive Oral Exam.................... |
- Included -
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$225
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$225
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| B. Panographic X-Ray................................................................ |
- Included -
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$118
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$118
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II. Dental Implant Surgery
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| A. Endosseous Implants - Root Form.......................................... |
$1,500
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$2,500
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$1,000
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| B. Ridge Augmentation - Bone Graft (Partial)................................ |
$650
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$1,250
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$600
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| C. Bone Graft to Correct Site Defects.......................................... |
$475
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$875
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$400
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| D. Sinus Augmentation (Per Sinus)............................................. |
$1,850
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$3,500
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$1,650
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| E. Sinus Lift with Apical Graft..................................................... |
$475
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$875
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$400
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| F. Extraction - General.............................................................. |
$150
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$250
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$100
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G. Extraction - Surgical.............................................................
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$225
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$350
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$125
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III. Dental Implant Prosthetics (Crown & Bridge)
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| A. Porcelain-Metal Implant Crown(s)............................................ |
$1,000
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$1,500
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$500
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| B. All Porcelain (Zirconia Base) Implant Crown(s).......................... |
$1,100
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$1,500
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$400
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| IV. Dental Implant Prosthetics (Overdenture) |
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| A. O-Ring Overdenture (includes O-Ring Attachments).................. |
$3,200
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$5,000
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$1,800
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| B. Hader Bar Overdenture w/ Hader Clips (includes Attachments).... |
$5,500
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$6,500
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$1,000
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| C. Fixed-Fixed Hybrid Prosthesis - FULL ARCH.............................. |
$5,500
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$10,500
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$5,000
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| D. ALL ON 6 - 6 Implants with Replacement Teeth (*All Inclusive).. |
$12,500
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$22,000
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$9,500
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| (ALL INCLUSIVE = Including extractions, bone grafts and TEMPS) |
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| V. Cosmetic Dental Services |
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| A. Porcelain Veneers................................................................... |
$950
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$1,350
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$400
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| B. InVisalign (Clear Braces)......................................................... |
$4,500
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$7,000
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$2,500
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| C. Tooth Whitening.................................................................... |
$150/per arch
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$250/per arch
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$100
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| VI. Implant Maintenance* |
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| A. Dental Cleaning...................................................................... |
$75
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$93
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$18
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| B. Oral Examination.................................................................... |
$30
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$50
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$20
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| C. Panographic X-Ray................................................................. |
$45
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$118
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$73
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| D. Dental Cleaning, Oral Examination and Panographic X-Ray.......... |
$150
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$261
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$111
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* Required 2 (two) per year to maintain 10-year warranty
Implant hygiene appointments and cleanings must be provided and documented by a Resource 1 Provider.
IMPLANT SURGERY INCLUDES:
- Dental Implant Placement
- Local Anesthetic
- Follow Up Examination(s)
NOTE: IMPLANT PLACEMENT FEE DOES NOT INCLUDE:
- IV Sediation
**Anything not defined in the Resource 1 Fee Schedule is the providers U/C fee.
Subject: PPA-10ILRev