Common use of CHOICECARE NETWORK REIMBURSEMENT Clause in Contracts

CHOICECARE NETWORK REIMBURSEMENT. Group agrees to accept as payment in full from Payors for Covered Services rendered to Members, the percentage defined below of ChoiceCare’s ( 079-787 ) fee schedule, or Group’s billed charges, whichever is less, less any Co-payments due from Members. All payments from ChoiceCare will be reduced by any deductibles or co-payments due from Member. Reimbursements broken down by code ranges and percentage payable for the above listed plans indicating (079-787) fee schedule: • Evaluation and Management Services (Codes 99201 to 99499): ALl covered services for evaluation and management services will be reimbursed zero with the exception of 99214, 99215, and 99212. CPT Code 99214 will be reimbursed at [****] of fixed 2006 Medicare RBRVS schedule. CPT Code 99215 will be reimbursed at [****]. CPT Code 99212 which will be [****]. • Surgery Services (Codes 10021 to 11471): CPT Code 10060, 10120, 11100, will be reimbursed at[****]. All other covered services for surgery services will be reimbursed at [****]. • Surgery Services (Codes 11600 to 11719 and 11770 to 69990): CPT code 11730, 11740, 11750, 12001, 12002, 12004, 12011, 12013, 12014, 12031, 12032, 12034, 12041, 12042, 12044, 12051, 12052, 12053, 16020, 16025, 16030, 17110, 29505, 20515, 29125, 29105, 29130, 30901, 65205, 65220, and 69210 will be reimbursed at [****]. All other covered services for radiology services will be reimbursed at [****]. • Radiology - Including Nuclear Medicine and Diagnostic Ultrasound Services (Codes 70010 to 79999): All covered services for radiology services will be reimbursed at [****]. [****] Certain information on this page has been omitted and filed separately with the Commission. Confidential treatment has been requested with respect to the omitted portions. • Pathology and Laboratory Services (Codes 80048 to 89399): ChoiceCare’s STAT pathology and laboratory codes are fixed at [***]. ChoiceCare’s STAT laboratory codes are as follows: 81000, 81002, 81005, 81015, 81025, 82270, 82947, 82948, 85007, 85008, 85009, 85013, 85014, 85021, 85022, 85027, 85031, 87205, 87207, 87210, 87220, and 87880. CPT Code 36415 when appropriate will be paid at [****]. CPT Codes 82962, 86677, 87804, and 86308, will be paid at [****]. All other covered services for pathology and laboratory will be reimbursed at [****]. • Medicine Services (except Anesthesiology and vaccines) (Codes 90281 to 90474 and 90760 to 92504 and 92511 to 96999 and 97802 to 98929 and 99000 to 99199 and 99500 to 99600): CPT Codes 90772, 92230, 93000, 94640, and 94664 will be reimbursed at [****]. All other covered services for medicine services, excluding anesthesiology, will be reimbursed at [****]. • Medicine Services Chiropractic, Physical Therapy, Speech Therapy and Occupational Therapy (except Anesthesiology) (Codes 92506 to 92508 and 97001 to 97606 and 98940 to 98943): All covered services for medicine services, excluding anesthesiology, will be reimbursed at [****].

CHOICECARE NETWORK REIMBURSEMENT. Group agrees to accept as payment in full from Payors for Covered Services rendered to Members, the percentage defined below of ChoiceCare’s ( 079-787 ) fee schedule, or Group’s billed charges, whichever is less, less any Co-payments due from Members. All payments from ChoiceCare will be reduced by any deductibles or co-payments due from Member. Reimbursements broken down by code ranges and percentage payable for the above listed plans indicating (079-787) fee schedule: • Evaluation and Management Services (Codes 99201 to 99499): ALl covered services for evaluation and management services will be reimbursed zero with the exception of 99214, 99215, and 99212. CPT Code 99214 will be reimbursed at [****] of fixed 2006 Medicare RBRVS schedule. CPT Code 99215 will be reimbursed at [****]] of fixed 2006 Medicare RBRVS schedule. CPT Code 99212 which will be [****]] of the fixed 2006 Medicare RBRVS schedule. • Surgery Services (Codes 10021 to 11471): CPT Code 10060, 10120, 11100, will be reimbursed atat [****]] of the fixed 2006 Medicare RBRVS schedule. All other covered services for surgery services will be reimbursed at [****]] of fixed 2006 Medicare RBRVS schedule. • Surgery Services (Codes 11600 to 11719 and 11770 to 69990): CPT code 11730, 11740, 11750, 12001, 12002, 12004, 12011, 12013, 12014, 12031, 12032, 12034, 12041, 12042, 12044, 12051, 12052, 12053, 16020, 16025, 16030, 17110, 29505, 20515, 29125, 29105, 29130, 30901, 65205, 65220, and 69210 will be reimbursed at [****]] of the fixed 2006 Medicare RBRVS schedule. All other covered services for radiology services will be reimbursed at [****]] of fixed 2006 Medicare RBRVS schedule. • Radiology - Including Nuclear Medicine and Diagnostic Ultrasound Services (Codes 70010 to 79999): All covered services for radiology services will be reimbursed at [****]] of fixed 2006 Medicare RBRVS schedule. [****] Certain information on this page has been omitted and filed separately with the Commission. Confidential treatment has been requested with respect to the omitted portions. • Pathology and Laboratory Services (Codes 80048 to 89399): ChoiceCare’s STAT pathology and laboratory codes are fixed at [***]*] of fixed 2006 Medicare RBRVS schedule. ChoiceCare’s STAT laboratory codes are as follows: 81000, 81002, 81005, 81015, 81025, 82270, 82947, 82948, 85007, 85008, 85009, 85013, 85014, 85021, 85022, 85027, 85031, 87205, 87207, 87210, 87220, and 87880. CPT Code 36415 when appropriate will be paid at [****]] of the fixed 2006 RBRVS schedule. CPT Codes 82962, 86677, 87804, and 86308, will be paid at [****]] of the fixed 2006 Medicare RBRVS allowable. All other covered services for pathology and laboratory will be reimbursed at [****]. • Medicine Services (except Anesthesiology and vaccines) (Codes 90281 to 90474 and 90760 to 92504 and 92511 to 96999 and 97802 to 98929 and 99000 to 99199 and 99500 to 99600): CPT Codes 90772, 92230, 93000, 94640, and 94664 will be reimbursed at [****]] of the fixed 2006 RBRVS schedule. All other covered services for medicine services, excluding anesthesiology, will be reimbursed at [****]] of 2006 Medicare RBRVS. • Medicine Services Chiropractic, Physical Therapy, Speech Therapy and Occupational Therapy (except Anesthesiology) (Codes 92506 to 92508 and 97001 to 97606 and 98940 to 98943): All covered services for medicine services, excluding anesthesiology, will be reimbursed at [****]] of 2006 Medicare RBRVS.

CHOICECARE NETWORK REIMBURSEMENT. Group agrees to accept as payment in full from Payors for Covered Services rendered to Members, the percentage defined below of ChoiceCare’s ( 079-787 ) fee schedule, or Group’s billed charges, whichever is less, less any Co-payments due from Members. Members All payments due from ChoiceCare will be reduced by any deductibles or co-payments due from Member. Reimbursements broken down by code ranges and percentage payable for the above listed plans indicating (079070-787) fee schedule: • Evaluation and Management Services (Codes 99201 to 99499): ALl All covered services for evaluation and management services will be reimbursed zero [****] with the exception of 99214, 99215, 99214 and 99212. CPT Code 99214 will be reimbursed at [****] of fixed 2006 Medicare RBRVS schedule. CPT Code 99215 will be reimbursed at [****]. CPT Code 99212 which will be [****]. • Surgery Services (Codes 10021 to 1147111471 and 11720 to 11765): CPT Code 10060, 10120, 11100, 10060 will be reimbursed atat [****]. All other covered services for surgery services will be reimbursed at [****]. • Surgery Services (Codes 11600 to 11719 and 11770 to 69990): CPT code 11730, 11740, 11750, 12001, 12002, 12004, 12011, 12013, 12014, 12031, 12032, 12034, 12041, 12042, 12044, 12051, 12052, 12053, 16020, 16025, 16030, 17110, 29505, 20515, 29125, 29105, 29130, 30901, 65205, 65220, Code 11740 and 69210 will be reimbursed at [****]. All other covered services for radiology surgery services will be reimbursed at [****]. • Radiology - – Including Nuclear Medicine and Diagnostic Ultrasound Services (Codes Code 70010 to 79999): All covered services for radiology services will be reimbursed at [****]. [****] Certain information on this page has been omitted and filed separately with the Commission. Confidential treatment has been requested with respect to the omitted portions. • Pathology and Laboratory Services (Codes 80048 to 89399): ChoiceCare’s STAT pathology and laboratory codes are fixed at [***]*] schedule. ChoiceCare’s STAT laboratory codes are as follows: 81000, 8100291002, 81005, 81015, 81025, 82270, 82947, 82948, 85007, 85008, 85009, 85013, 85014, 85021, 85022, 85027, 85031, 87205, 87207, 87210, 87220, and 87880. CPT Code 36415 when appropriate will be paid at [****]. CPT Codes 82962, 86677, 87804, and 86308, will be paid at [****]. All other covered services for pathology and laboratory will be reimbursed at [****]. • Medicine Services (except Anesthesiology and vaccines) (Codes 90281 to 90474 and 90760 to 92504 and 92511 to 96999 and 97802 to 98929 and 99000 to 99199 and 99500 to 99600): CPT Codes 90772, 92230, 93000, 94640, Code 90772 and 94664 92230 will be reimbursed at [****]. All other covered services for medicine services, excluding anesthesiology, will be reimbursed at [****]. • Medicine Services Chiropractic, Physical Therapy, Speech Therapy and Occupational Therapy (except Anesthesiology) (Codes 92506 to 92508 and 97001 to 97606 and 98940 to 98943): All covered services for medicine services, excluding anesthesiology, will be reimbursed at [****].

CHOICECARE NETWORK REIMBURSEMENT. Group agrees to accept as payment in full from Payors for Covered Services rendered to Members, the percentage defined below of ChoiceCare’s ( 079-787 ) fee schedule, or Group’s billed charges, whichever is less, less any Co-payments due from Members. Members All payments due from ChoiceCare will be reduced by any deductibles or co-payments due from Member. Reimbursements broken down by code ranges and percentage payable for the above listed plans indicating (079070-787) fee schedule: • Evaluation and Management Services (Codes 99201 to 99499): ALl All covered services for evaluation and management services will be reimbursed zero [****] with the exception of 99214, 99215, 99214 and 99212. CPT Code 99214 will be reimbursed at [****] of fixed 2006 Medicare RBRVS schedule. CPT Code 99215 will be reimbursed at [****]. CPT Code 99212 which will be [****]] of the fixed 2006 Medicare RBRVS schedule. • Surgery Services (Codes 10021 to 1147111471 and 11720 to 11765): CPT Code 10060, 10120, 11100, 10060 will be reimbursed atat [****]] of the fixed 2006 RBRVS schedule. All other covered services for surgery services will be reimbursed at [****]] of fixed Medicare RBRVS schedule. • Surgery Services (Codes 11600 to 11719 and 11770 to 69990): CPT code 11730, 11740, 11750, 12001, 12002, 12004, 12011, 12013, 12014, 12031, 12032, 12034, 12041, 12042, 12044, 12051, 12052, 12053, 16020, 16025, 16030, 17110, 29505, 20515, 29125, 29105, 29130, 30901, 65205, 65220, Code 11740 and 69210 will be reimbursed at [****]] of the fixed 2006 RBRVS schedule. All other covered services for radiology surgery services will be reimbursed at [****]] of fixed Medicare RBRVS schedule. • Radiology - – Including Nuclear Medicine and Diagnostic Ultrasound Services (Codes Code 70010 to 79999): All covered services for radiology services will be reimbursed at [****]. [****] Certain information on this page has been omitted and filed separately with the Commission. Confidential treatment has been requested with respect to the omitted portionsof fixed 2006 RBRVS schedule. • Pathology and Laboratory Services (Codes 80048 to 89399): ChoiceCare’s STAT pathology and laboratory codes are fixed at [***]*] of fixed 2006 Medicare RBRVS schedule. ChoiceCare’s STAT laboratory codes are as follows: 81000, 8100291002, 81005, 81015, 81025, 82270, 82947, 82948, 85007, 85008, 85009, 85013, 85014, 85021, 85022, 85027, 85031, 87205, 87207, 87210, 87220, and 87880. CPT Code 36415 when appropriate will be paid at [****]. CPT Codes 82962, 86677, 87804, and 86308, will be paid at [****]] of the fixed 2006 RBRVS schedule. All other covered services for pathology and laboratory will be reimbursed at [****]. • Medicine Services (except Anesthesiology and vaccines) (Codes 90281 to 90474 and 90760 to 92504 and 92511 to 96999 and 97802 to 98929 and 99000 to 99199 and 99500 to 99600): CPT Codes 90772, 92230, 93000, 94640, Code 90772 and 94664 92230 will be reimbursed at [****]] of the fixed 2006 RBRVS schedule. All other covered services for medicine services, excluding anesthesiology, will be reimbursed at [****]] 2006 Medicare RBRVS. • Medicine Services Chiropractic, Physical Therapy, Speech Therapy and Occupational Therapy (except Anesthesiology) (Codes 92506 to 92508 and 97001 to 97606 and 98940 to 98943): All covered services for medicine services, excluding anesthesiology, will be reimbursed at [****]] 2006 Medicare RBRVS.