|
Resource 1
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|
Member Fees
|
| Schedule A |
|
|
|
| I. Initial Diagnosis, Treatment Planning & Radiographic Procedures |
|
| A. Initial Consultation and Comprehensive Oral Exam |
- Included -
|
| B. Panographic X-Ray |
- Included -
|
|
|
| II. Dental Implant Surgery |
|
| A. Endosseous Implants - Root Form |
$1,450
|
| B. Ridge Augmentation - Bone Graft (Partial) |
$650
|
| C. Bone Graft to Correct Site Defects |
$475
|
| D. Sinus Augmentation (Per Sinus) |
$1,850
|
| E. Sinus Lift with Apical Graft |
$475
|
| F. Extraction - General |
$150
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| G. Extraction - Surgical |
$225
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|
|
| III. Dental Implant Prosthetics (Crown & Bridge) |
|
| A. Porcelain-Metal Implant Crown(s) |
$950
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| B. All Porcelain (Zirconia Base) Implant Crown(s) |
$1,000
|
| |
|
| IV. Dental Implant Prosthetics (Overdenture) |
|
| A. O-Ring Overdenture (includes O-Ring Attachments) |
$3,200
|
| B. Hader Bar Overdenture w/ Hader Clips (includes Attachments) |
$5,500
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| C. Fixed-Fixed Hybrid Prosthesis - FULL ARCH |
$5,500
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|
|
| V. Cosmetic Dental Services |
|
| A. Porcelain Veneers |
$950
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| B. InVisalign (Clear Braces) |
$4,500
|
| C. Tooth Whitening |
$150/per arch
|
|
|
| VI. Implant Maintenance* |
|
| A. Dental Cleaning |
$75
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| B. Oral Examination |
$30
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| C. Panographic X-Ray |
$45
|
| D. Dental Cleaning, Oral Examination and Panographic X-Ray |
$150
|
* 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-09-INRev