Prosthodontic Rates & Procedures
|
Regional Fee
|
Network Fee
|
Typical Network Savings |
Typical % Savings |
| Initial clinical exam |
$225 |
$150 |
$75 |
33% |
| Follow-up exam (established patient) |
$75 |
$45 |
$30 |
40% |
| Extended consultation (may include charting) |
$225 |
$150 |
$75 |
33% |
| Consultation or second opinion (may include charting) |
$195 |
$135 |
$60 |
31% |
| Emergency office visit |
$150 |
$110 |
$40 |
27% |
| Prophylaxis (when performed by hygienist) |
$115 - $140 |
$75 - $100 |
$40 |
31% |
| Prophylaxis (when performed by dentist) |
$165 |
$110 |
$55 |
33% |
| Antimicrobial Therapy, Initial Dose |
$160 |
$115 |
$45 |
28% |
| Antimicrobial Therapy, Additional Dose |
$60 |
$45 |
$15 |
25% |
| First Periapical X-ray |
$25 |
$15 |
$10 |
40% |
| Each Additional Periapical X-ray |
$20 |
$10 |
$10 |
50% |
| X-Ray Bite Wings (complete) |
$80 |
$45 |
$35 |
33% |
| X-Ray Panorex |
$125 |
$85 |
$40 |
32% |
| X-Ray Full Mouth, Including Bitewings (complete) |
$115 - $165 |
$85 |
$60 |
39% |
| Extraction (simple) |
$300 |
$200 |
$100 |
33% |
| Night Guard (acrylic - laboratory processed) |
$600 - $700 |
$450 |
$200 |
31% |
| Processed acrylic temps. |
$350 |
$250 |
$100 |
29% |
| Intra-Coronal Resin/Fiberglass Splint (per tooth) |
$250 |
$200 |
$50 |
20% |
| Models (if necessary), includes upper & lower |
$120 |
$85 |
$35 |
29% |
| White Composite Resin Fillings - Anterior |
- |
- |
- |
- |
| White composite resin filling - 1 surface - anterior |
$175 - $225 |
$140 |
$60 |
30% |
| White composite resin filling - 2 surface - anterior |
$235 - $285 |
$175 |
$85 |
33% |
| White composite resin filling - 3 surface - anterior |
$385 |
$285 |
$100 |
25% |
| White composite resin filling - 4 surface - anterior |
$450 |
$335 |
$115 |
25% |
| White Composite Resin Fillings - Posterior |
- |
- |
- |
- |
| White composite resin filling - 1 surface - posterior |
$185 - $235 |
$150 |
$60 |
29% |
| White composite resin filling - 2 surface - posterior |
$245 - $295 |
$185 |
$85 |
31% |
| White composite resin filling - 3 surface - posterior |
$385 |
$285 |
$100 |
25% |
| White composite resin filling - 4 surface - posterior |
$450 |
$335 |
$115 |
25% |
| Bonding Note: In some cases bonding is used for relatively small repairs and in other cases a larger portion of tooth surface is involved. Fees will vary accordingly and Network savings will be in the range of 33% for all bonding procedures. |
|
|
|
|
| Bonding, per tooth |
$350 - $700 |
$200 - $550 |
$175 |
33% |
| Note: Fees vary for some procedures, as shown, based upon materials, lab fees, and other professional considerations. Dentist will confirm UCR fee and variables, if any, upon request. |
- |
- |
- |
- |
| Cosmetic Procedures: |
- |
- |
- |
- |
| Diagnostic Waxup (treatment planning and aesthetic workup) |
$2000 |
$1750 |
$250 |
12% |
| Porcelain Laminate Veneer |
$1400 - $1700 |
$1100 - $1325 |
$338 |
22% |
| Porcelain Inlay (including composite temp.) |
$1550 |
$1150 |
$400 |
26% |
| Cosmetic Tooth Whitening: Includes Oral Exam, Two office visits, Full mouth impressions and models, Whitening trays, All materials, At home application of whitening material (See exam* and prophylaxis notes below.) |
$350 - $500 |
$275 |
$150 |
35% |
| Cosmetic Tooth Whitening: Accelerated tooth whitening procedure using high intensity light, includes one or more office visits, Oral Exam, All materials. (See exam* and prophylaxis notes below.) |
$450 - $550 |
$325 |
$175 |
35% |
Cosmetic Tooth Whitening: Accelerated tooth whitening procedure using high intensity light, includes one or more office visits, Oral Exam, All materials. (See exam* and prophylaxis notes below.) Alternate Fee - Certain Manhattan Locations Only - Please consult with your dentist. |
$550 - $650 |
$375 |
$225 |
37% |
| Cosmetic Tooth Whitening: Accelerated tooth whitening procedure using high intensity light, includes one or more office visits, Oral Exam, Full mouth impressions and models, Whitening Trays, All materials for at-home follow up. Combines office and take-home procedures shown above. (See exam* and prophylaxis notes below.)
| $650 - $800 |
$500 - $550 |
$200 |
28% |
| *Tooth Whitening/Bleaching exam notes:
Your dentist must determine that teeth and gums are in suitable conditon, and which process may be most appropriate, prior to cosmetic tooth whitening. If prophylaxis has not been performed recently, your dentist may require same. The additional fee for prophylaxis, if necessary, will be the adult or child prophylaxis fee shown on this schedule. |
- |
- |
- |
- |
| Crowns and Fixed Bridgework: |
- |
- |
- |
- |
| Crown (Porcelain fused to High Noble Metal) |
$1400 - $1800 |
$1250 - $1500 |
$225 |
14% |
| Crown, per tooth if fixed bridge |
$1400 - $1800 |
$1250 - $1500 |
$225 |
14% |
| All Porcelain Crown |
$1600 - $2100 |
$1350 - $1600 |
$375 |
20% |
| Cad-Cam Crown |
$1650 - $2150 |
$1400 - $1650 |
$375 |
20% |
| Gold Onlay |
$1400 - $1800 |
$1250 - $1500 |
$225 |
14% |
| Porcelain Onlay |
$1750 |
$1250 - $1500 |
$375 |
21% |
Provisional (temporary) Crown interim short-term restoration |
$350 |
$225 |
$125 |
36% |
| Post and Core (Prefab.) |
$450 |
$350 |
$100 |
22% |
| Post and Core (Cast) |
$700 - $750 |
$550 |
$157 |
24% |
| Implants: |
- |
- |
- |
- |
| Implant (Surgical Fee) does not include prosthetics (Crown) |
$2300 - $2500 |
$1500 - $1750 |
$775 |
32% |
| Implant Supported Crown (does not include abutment) |
$1500 - $1800 |
$1350 - $1450 |
$250 |
15% |
| *Abutment for implant supported crown may be custom or prefab depending upon details of each case. Cost will vary based upon degree of difficulty and time and materials and lab charges, if applicable. Please ask your dentist about UCR so that you can determine savings in network. |
- |
- |
- |
- |
| Custom *Abutment in addition to Crown |
$550 - $1050 |
$450 - $950 |
$100 |
12% |
| Prefab *Abutment in addition to Crown |
$450 - $750 |
$300 - $450 |
$225 |
37% |
| Anesthesia and Analgesia - In some cases, the cost of Inhalation Analgesia (nitrous oxide) may be included in cost of the procedure. In other cases, a separate fee, as shown on this schedule, may apply. In general, fees for Analgesia and for IV Sedation are based upon time required for each procedure. In some dental procedures, conventional medical insurance may cover a portion of the surgical or anesthesia fees. Consult with your dentist about his/her fees for Analgesia and Anesthesia to determine network savings. |
|
|
|
|
| Inhalation Analgesia (Nitrous Oxide) |
$65 - $95 |
$45 |
$35 |
44% |
| IV Conscious Sedation (first 30 minutes) |
$350 - $500 |
$250 |
$175 |
41% |
| IV Conscious Sedation (additional 15 minutes) |
$180 - $220 |
$100 |
$100 |
50% |
| Dentures: |
- |
- |
- |
- |
| Lab hard reline (per arch) |
$1000 - $1250 |
$800 - $950 |
$250 |
22% |
| Complete Denture (per arch) |
$2800 - $3600 |
$2000 - $2600 |
$800 |
26% |
| Transitional Partial Denture (lab processed) |
$1700 |
$1300 - $1500 |
$300 |
18% |
| Interim Partial Denture (flipper) |
$850 |
$650 |
$200 |
24% |
| Semi-Precision Partial Denture |
$3000 - $4000 |
$2000 - $3000 |
$1000 |
29% |
| Clasp Partial Denture |
$2500 - $3500 |
$2000 - $2500 |
$750 |
25% |
| Note: Implant Supported Bar Overdenture - please consult with dentist due to variation in treatment and professional fees associated with this procedure |
- |
- |
- |
- |
| Implant Supported Bar Overdenture (consult with dentist) |
$10,000 |
$8,000 |
$2000 |
20% |