* Patients 21 years of age or older are considered adults.
| Covered Procedure | Office UCR Fee | Discount Plan Fee |
|---|---|---|
|
$125 | $0 |
|
$95 | $0 |
|
$65 | $0 |
|
$175 | $0 |
|
$85 | $0 |
|
$175 | $0 |
|
$140 | $0 |
|
$155 | $0 |