this amendment, effective on april 1, 2009 (effective date...

FIRST AMENDMENT TOUNITEDHEALTHCARE PHYSICIAN CONTRACT

This Amendment, effective on April 1, 2009 ("Effective Date"), is made to theagreement ("Agreement") between UnitedHealthcare Insurance Company, contracting on behalfof itself, PacifiCare of California, and the other entities that are United's Affiliates, collectivelyreferred to as ("United") and Ukiah Valley Primary Care Medical Group.

WHEREAS, the parties wish to continue their Agreement for a period of time based onthe terms and conditions set forth below;

NOW, THEREFORE, the parties hereto agree as follows:

Appendix 3, entitled Fee Schedule Sample, made a part of and attached tothe Agreement is deleted in its entirety and replaced with the Appendix 3

All other provisions of the Agreement shall remain in full force and effect.

PHYSICIAN TIN:

680345883

UNITED ENTITYUnitedHealthcare Insurance Company, on behalf of itself,PacifiCare of California, and the other entities that areUnited's Affiliates

5757 Plaza DriveMail Stop CAl24-0115Cypress, CA 90630

Signature:

Print Name: Leslie Carter

Title: VP Network Management

Fax ti: 714-226-8513

1

Ukiah Valley Primary Care Medical Group Tax Id 680345883

Appendix 3Fee Schedule Exhibit: All Commercial Products

Representative All Payer Fee Schedule Sample: CA6218 and CA6219

Unless another fee schedule to this agreement applies specifically to a particular benefit contractas it covers a particular customer, the provisions of this appendix apply to covered servicesrendered by you to customers covered by benefit contracts sponsored, issued or administered by

all participating entities

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees

and may be subject to reductions based on appropriate modifier (for example, professional andtechnical modifiers). Any co-payment, deductible or coinsurance that the customer is responsibleto pay under the customer's benefit contract will be subtracted from the listed amount indetermining the amount to be paid by the payer. The actual payment amount is also subject tomatters described in this agreement, such as the reimbursement policies. Please remember thatthis information is subject to the confidentiality provisions of this agreement.

2

Ukiah Valley Primary Care Medical Group Tax Id 680345883

!jà

J2505

Last Routine Maintenance Update: 01-01-2009Default Percent of Charges: 50.00%Anesthesia Conversion Factor: $ 60.00Anesthesia Rounding Option: Proration

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount tobe paid by the payer. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. Please remember that this information is subjectto the

confidentiality provisions of this agreement.

Note: Maintenance to this fee schedule occurs routinely and may still occur after the report date for the fee amounts selected.

Confidential and Proprietary Not for Distribution to Third Parties

COLONOSCOPY FLEXCOLONOSCOPY FLEXROUTINE OB CARE'ROUTINE OB CAREMRI BRAIN, W/O TMRI BRAIN; W/O TMRI BRAIN, W/O TMYOCARD PERFUS IMYOCARD PERFUS IMYOCARD PERFUS ILEVEL IV - SURG

--LEVEL IV - SURGLEVEL IV SURGIMMUNIZATION ADMPNEUMOCOCCAL CONECG-ROUTINE 12 LTTHRC R-T IMG 2D

-TTHRC R-T IMG 2DTTHRC R-T IMG 20DOPPLR ECHO COLODOPPLR ECHO COLODOPPLR ECHO COLOTHERAP V> AREASCMT SPI 1-2 REGI

Woil oo CMT SP 3-4 REGI992-62 00 OFFICE OUTPT NEW99203 60 OFFICE OUTPT NEW

99204 00 OFFICE OUTPT NEW

99205 --BF- -OFFTEE-0-úTP-TNEii--9921200 OFC/OUTPT E&M ES99213 00 OFC/OUTPT E&M ES99214 -00 OFC/OUTPT E&M ES

9921-5- 00- OFC/OUTPT E&M ES

99223 00 INIT HOSP-DAY ES99232 00 SUBSQT HSP-DAY E

908- 00- ---gb BS QT -1-1-6S-P-D AY99243 06 60i-di b4§--CliiNva99244 00 OFC crsisa NEW/E-g-

.

99215, .

00 OFC CNSLT NEW/ES

99283 00 E-MERG DEPT ViSIT

99284 ---60 ER 'VISIT -E&V'HIG EVALUATION &MANAGEMENT NonFac S-133 85'

99285 00 -ER VISIT E&M

99391 00- PER-01.- DiC-PREVINT--99392 00 PERIODIC' PREVENT--

99393 06 PERIODIC PREVENT99394 00-- PE R-1-0--DIC-P-RWENT-99395 00 PERIODIC PREVENT

00 PERIODIC PREVENTJ1745 00 INJECTION INFLIX

IN-JECTION PEG-FTL-

ALL COMMERCIAL PRODUCTSRepresentative Fee Schedule Sample for : CA 6218

Fee amounts as of:0210112009Report Date:01/09/2009*

Site of Service - Linked Schedule ID: CA 6219CPT Description Type of Service Place of Service Fee

SURGERY - DIGESTIVESURGERY - DIGESTIVEOBSTETRICS GLOBALOBSTETRICS - GLOBALRADIOLOGY MRIRADIOLOGY MRIRADIOLOGY - MRIRADIOLOGY - NUCLEAR MEDICINERADIOLOGY - NUCLEAR MEDICINERADIOLOGY NUCLEAR MEDICINELAB - PATHOLOGYEA-II7PATHOLOGYLAR - PATHOLOGYMEDICINE- OTHERIMMUNCZATIONSMEDICINE - OTHERMEDICINE CARDIOVASCULARMEDICINE CARDIOVASCULARMEDICINE - CARDIOVASCULARMEDICINE - CARDIOVASCULARMEDICINE - CARDIOVASCULARMEDICINE - CARDIOVASCULARMEDICINE - OTHERMEDICINE CHIROPRACTIC MANIPULATIVE TREATMENTMEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT--EVALUATION & MANAGEMENTEVALUATION & MANAGEMENT'EVALUATION &-MANAGEMENT'EVALUATION & MANAGEMENTEVAATION 8. MANAGEMENTCU

EVALUATION & MANAGE'MENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENT

A UnitedHealth Group Company

EVALUATION & MANAGEMENT - PREVENTIVEEVALUATION & MANAGEMENT - PREVENTIVEINJECTABLES-ONCOLOGYTTHERAPEUTIC CHEMO DRUG6--INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS

UnitedHealthcar6

$ 3011.22

, _$721.02$ 84.69

NonFac $ 636.33NN;onan:acC-- -$.593:33

$ 55.42Non

NonFac$ 337.97ra'c

Non-Fac

N., o_n.F. ...a c

SY476-7-

$ 100.51

$ 21-.61

NonFac

giiiiziNonFacNonFac

NonFac

$243.74

"N-óriFeC-

1110803..-7597--$ 59.97NonFac

NonFac

ITIO'n-Eac ---$'$ :3:79 95:

NonFac

$ 28.74

NonFacNon Fa7.- 5$ 32.82-NonFac

$$$ 214711301 S$386$

NoriFacNonFar

NNOtFFaae $4587

NonFac $$17105-4458

NonFac

NonFa.: $14929

NonFac

NonFacNon Fac

NonFac

. . . ..... . _ÉVALLiATION-& MANAGEMENT- $ 199 83

EVALUATION & MANAGEMENT :PREVENTIVE NonFac $ 85 42

EVALUATION-8 MANAGEMENT PREVENTIVE NonFac $ 95 42

EVALLrATION &MANAGEMENT :PREVENTIVE.

NonFac $ 94-.51- .

EVALUATION & MANAGEMENT - PREVENTIVE NonFac -----$76Yei-NonFac $ 104.51NonFac 014.51NonFac $ 60.50NonFac $ 2328.34

EVALUATION-8 MANAGEMENT NonFac $ 211.06

EVALUATION & MANAGEMENT NonFac $ 77.86

EVALLATTON & MANA-GEMENT NonFiC 7 --7 $ 111 34-,....._._ ........_

EVALUATION & MANAGEMENT NonFac $ 150 23

EVALUATION & MANAGEMENT- - -

NonF ac_ .

$ 219 96- .

EVALUATION 8 MANAGEMENT NonFac $ 271 43

EVALUATION'S, MANAGEMENf NonFac $ 72 53_

Page 1

CPT Mod

45378 0045380 00594-56 0-0---59510 0070553 0070553 2670553 TC78465 0078-48-5- 26

78465 TC88305 0088305 2688305 TC-904 009086993000 0"93'3"57 iO

93307 2693307 TC93325 0093325 2693325 TC97110 -0098940 00

NonFac $ 488.64

NonFac $ 583.68NonFac $2659.70

CA 6218

Market

California

Type Of Service

MktStdID

CMScarrierlocality

CA 6218 0000000 NonFac

EVALUATION & MANAGEMENTEVALUATION & MANAGEMENT - NEONATALEVALUATION & MANAGEMENT PREVENTIVESURGERY - INTEGUMENTARYSURGERY - MUSCULOSKELETALSURGERY - RESPIRATORYSURGERY - CARDIOVASCULARSURGERY - HEMIC & LYMPHATICSURGERY MEDIAST1NUM & DIAPHRAGMSURGERY - DIGESTIVESURGERY - URINARYSURGERY - MALE GENITALSURGERY - FEMALE GENITALSURGERY MATERNITY & DELIVERYSURGERY - ENDOCRINESURGERY NERVOUSSURGERY - EYE & OCULAR ADNEXASURGERY - AUDITORYRADIOLOGYRADIOLOGY - BONE DENSITYRADIOLOGY - CTRADIOLOGY- MAMMOGRAPHYRADIOLOGY - MRIRADIOLOGY - MRARADIOLOGY - NUCLEAR MEDICINERADIOLOGY - PET SCANSRADIATION THERAPYRADIOLOGY - ULTRASOUNDLAB PATHOLOGYOFFICE LABCLINICAL LABORATORYMEDICINE - OPHTHALMOLOGYMEDICINE - CARDIOVASCULARMEDICINE ALLERGY & CLINICAL IMMUNOLOGYMEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENTMEDICINE - MODALITIES, THERAPIESMEDICINE - OTHERMEDICINE. CHEMO ADM1NOBSTETRICS - GLOBALIMMUNIZATIONSINJECTABLES/OTHER DRUGSINJECTABLES ONCOLOGWTHERAPEUTIC CHEMO DRUGSINJECTABLES - IVIGINJECTABLES-SALINE & DEXTROSE SOLUTIONSDME & SUPPLIESDME & SUPPLIES - RESPIRATORYDME & SUPPLIES ORTHOTICSDME & SUPPLIES - PROSTHETICSAMBULANCE

Hard Codes78459 $1800.00 78478 -$47.25 78480- $47.25 78491 -$1800.00$1800.00 78815 -$1800.00 78816 -$1800.00Default Percent of Charges: 50.00%CMS Modifier PricingSite of Service: Yes - CMS Assignment (ASO POS 24 = F)Anesthesia Conversion Factor $ 60.00Anesthesia Rounding Option: ProrationSchedule Type: FFS

Site of Service Linked Schedule ID

CA 6219

UnitedHealthcar6igA UnitedHeanh Group Company

ALL COMMERCIAL PRODUCTSMarket Standard Specifications

California Market(s)Specifications as of:0210112009

Report Date:0110912009 *

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global feesand may be subject to reductions based on appropriate modifier (for example, professional and technical

modifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customer'sbenefit contract will be subtracted from the listed amount in determining the amount to

be paid by the payer. The actual payment amount is also subject to matters described in this agreement,such as the payment policies. Please remember that this information is subject to the

confidenfiality provisions of this agreement.

Confidential and Proprietary Not for Distribution to Third PartiesPage 2

Primary Fee Source Pricing Level

2008 CMS RBRVS (0000000) 122.876%

2008 CMS RBRVS (0000000) 123.192%

2008 CMS RBRVS (0000000) 119.306%

2008 CMS RBRVS (0000000) 118.203%

2008 CMS RBRVS (0000000) 128.863%

2008 CMS RBRVS (0000000) 118.019%

2008 CMS RBRVS (0000000) 133.431%2008 CMS RBRVS (0000000) 114.632%

2008 CMS RBRVS (0000000) 136.109%

2008 CMS RBRVS (0000000) 130.648%

2008 CMS RBRVS (0000000) 143.487%

2008 CMS RBRVS (0000000) 125.66%

2008 CMS RBRVS (0000000) 115.315%

2008 CMS RBRVS (0000000) 133.536%

2008 CMS RBRVS (0000000) 122.194%

2008 CMS RBRVS (0000000) 129.939%


2008 CMS RBRVS (0000000) 74.619%

2008 CMS RBRVS (oop0000) 72.649%

2008 CMS.RBRVS (0000000) 74.619%


2008 CMS RBRVS (0000000) 74.619%2008 CMS RBRVS (0000000) 74,619%2008 CMS RBRVS (0000000) 74.619%2008 CMS RBRVS (0000000) 74.619%2008 CMS RBRVS (0000000) 74 619%

2008 CMS RBRVS (0000000) 59.705%

2008 CMS Clinical Lab Schedule - National Lirnit 60.000%2008 CMS Clinical Lab Schedule - National Limit 42.000%

2008 CMS RBRVS (0000000) /05.364%2008 CMS RBRVS (0000000) 126 972%

2008 CMS RBRVS (0000000) 123.087%

2008 CMS RBRVS (0000000) 119.805%

2008 CMS RBRVS (0000000) 120 986%

2008 CMS RBRVS (0000000) 121.38%

2008 CMS RBRVS (0000000) 156.615%

2008 CMS RBRVS (0000000) 159.398%

Redbook J Code-CPT Code AWP 100.000%

CMS Drug Pncing 100.000%

CMS Drug Pricing 106.000%



2008 CMS DME Ceiling 75.000%2008 CMS DME Ceiling 75.000%

2008 CMS DME Ceiling 75.000%

2008 CMS DME Ceiling 75.000%2008 CMS Ambulance Schedule - Urban (0000000) 100.000%

78492 - $1800.00 78608 -$1800.00 78609 -$1800.00 78811 -$1800.00 78812 -$1800.00 78813 - $1800.00 78814 -

t..

453784-5266-

3951070553

7055370553784657846576415 TC88305883058830590471906699300093307

9330793307933259332593325

99212

99213'99214992159922399232--992339924399244

9924599283992849928599391

99392

9939599396J1745J2505

00

9894098941

992025920399264'99205

9939399394

000000

000000

00

00

0000

00

0000

INJECTION INFLIXI NJECIT6N-Fdair-

TC DOPPLR ECHO COLO97110 00

SURGERY - DIGESTIVESURGERY - DIGESTIVEOBSTETRICS - GLOBAL

-63-STETRICS - GLOBALRADIOLOGY MRIRADIOLOGY MRIRADIOLOGY - MRIRADIOLOGY NUCLEAR MEDICINERADIOLOGY - NUCLEAR MEDICINERADIOLOGY NUCLEAR MEDICINELAB - PATHOLOGYLAB - PATHOLOGYLAB PATHOLOGYMEDICINE - OTHERIMMUNIZATIONSMEDICINE - OTHERMEDICINE CARDIO AJLAR

MEDICINE - CARDIOVASCULARMEDICINE CARDIOVASCULARMEDICINE - CARDIOVASCULARMEDICINE - CARDIOVASCULARMEDICINE CARDIOVASCULARMEDICINE - OTHERMEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENTMEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALdATICTN & MANAGEMENTEVALUATION & MANAGEMENTEVALUATIÓN-i MANAGEMENT --EVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEvALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENTEVALUATION & MANAGEMENT - PREVENTIVEEVALUATION & MANAGEMENT PREVENTIVE

-EVALUATION & MANAGEMENT - PREVEN-f IVEEVALUATION & MANAGEMENT PREVENTIVEEVALUATION & MANAGEMENT - PREVENTIVEEVALUATION & MANAGEMENT PREVENTIVEINJECTABLES-ONCOLOGYfTHERAPEUTIC CHEMO DRUGSiisik-6-fAliEn-Z-F4Tol-56,7n-RE"-FiA-1 1-0-iY6 CHEmóc,ROG§---

$ 258.75Fac

Fac $ 310.50Fac 2659.70

3611.22-$ 721.02$ 84.69

$ 6361-h-$ 393.33$ 55.42

$

$ 61.4o$ 21.61

$ 39.79$ 24.97

-$ 106:51-$ 27.74

$ 243.74$ 59.97

$ 183.77$ 100.59

$ 4.84$ 95.75$ 32.82$ 24.19_ ES 34.23

Fac

Fac

FdcFacFacFacFacFacFacFac

FacFacFacFacFacFacFacFacFac s 52.42Fac $ SOISò

$ 133.85FacFc $

Pac $ 51.49-Fac $ 80.50Fa( $115.59Fac S211.06Fac 3 77.68Fac $ 111.39Fac $ 114.19

$ 178.77Fac $ 224.64

$ 72.53

$ 199.83

$ 66.35..._Fac $ 66.35Fac $ 75.89

FacFac

Fac $ 75.89Fac $ 85.42Fac $ 60.50Fac $ 2328.34

opA UnitedHealth Group Company

UnitedHealthcare6

ALL COMMERCIAL PRODUCTSRepresentative Fee Schedule Sample for : CA 6219

Fee amounts as of:0210112009Report Date:0110912009 *

Site of Service - Linked Schedule ID: CA 6218


Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customers benefit contract will be subtracted from the listed amount in determining the amount tobe paid by the payer. The actual payment amount is also subject lo matters described in this agreement, such as the payment policies. Please remember that this information is subject to theconfidentiality provisions of this agreement.



Page 3

CPT Mod CPT Description Type of Service Place of Service Fee

COLONOSCOPY FLEXCOLONOSCOPY FLEX

ROUTINE OB CARE00 MRI BRAIN; W/O T26 MRI BRAIN; W/O TTC MRI BRAIN; W/O T00 MYOCARD PERFUS I26 MYOCARD PERFUS I

MYOCARD PERFUS I00 LEVEL IV - SURG26 LEVEL IV SURGTC LEVEL IV - SURG00 IMMUNIZATION ADM00 PNEUMOCOCCAL CON00 ECG-ROUTINE 12 L00 TTHRC R-T IMG 2D26 TTHRC R-T !MG 2D

TTHRC R-T IMG 2DDOPPLR ECHO COLO

26 DOPPLR ECHO COLO

THERAP 1/> AREAS00 CMT SPI 1-2 REGI00 CMT SPI 3-4 REGI

OFFICE OUTP-f NEw'OFFICE OW Fif NEWOFFICE OOTPT NEIX,

00 OFFICE OUTPT NEVV

-66- f,/,

"---óRiötifi3i----Ein-4 ES00 OFC/01.1iPT 'E&M.ES-

OFC/OUTPT E&M ESINIT HOSP-DAY E&SUBSQT HSP:DAY ÉSUBSQT HOSP-DAYOFFICE CNSLT NEWOFC CNSLT NEVV/ES

00 OFC CNSLT NEW/ESEMERG DEPT VISITER VISIT E&M HIGER VISIT E&M HIGPERIODIC PREVENTPERIODIC PREVENTpEFilöbic pkE\i6i-r

oo PERIODIC PREVENT00 PERIODIC PREVENT00 PERIODIC PREVENT

78459 -$1800.00 78478 -$47.25 78480 - $47.25 78491 -$1800.00$1800.00 78815 -$1800.00 78816 -$1800.00Default Percent of Charges: 50.00%CMS Modifier PricingSite of Service: Yes - CMS Assignment (ASC POS 24 = F)Anesthesia Conversion Factor $ 60.00Anesthesia Rounding Option: ProrationSchedule Type: FFS

ILUnitedHealthcarew


ALL COMMERCIAL PRODUCTSMarket Standard Specifications

California Market(s)Specifications as of:0210112009

Report Date:01/0912009*CA 6219

78492 -$1800.00 78608 -$1800.00 78609 -$1800.00 78811 -$1800.00 78812 -$1800.00 78813 -$1800.00 78814 -

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount tobe paid by the payer. The actual payment amount is also subject lo matters described in this agreement, such as the payment policies. Please remember that this information is subject to theconfidentiality provisions of this agreement.


Page 4

Market Mkt CMS Site of Service Linked Schedule IDStd carrierID locality

California CA 6219 0000000 Fac CA 6218

Type Of Service Primary Fee Source Pricing Level

EVALUATION & MANAGEMENT 2008 CMS RBRVS (0000000) 122.876%EVALUATION & MANAGEMENT - NEONATAL 2008 CMS RBRVS (0000000) 123.192%EVALUATION & MANAGEMENT - PREVENTIVE 2008 CMS RBRVS (0000000) 119.306%SURGERY - INTEGUMENTARY 2008 CMS RBRVS (0000000) 118.203%SURGERY - MUSCULOSKELETAL 2008 CMS RBRVS (0000000) 128.863%SURGERY - RESPIRATORY 2008 CMS RBRVS (0000000) 118.019%SURGERY - CARDIOVASCULAR 2008 CMS RBRVS (0000000) 133.431%SURGERY - HEMIC & LYMPHATIC 2008 CMS RBRVS (0000000) 114.632%SURGERY - MEDIASTINUM & DIAPHRAGM 2008 OMS RBRVS (0000000) 136.109%SURGERY - DIGESTIVE 2008 CMS RBRVS (0000000) 130.648%SURGERY URINARY 2008 CMS RBRVS (0000000) 143.487%SURGERY - MALE GENITAL 2008 CMS RBRVS (0000000) 125.66%SURGERY - FEMALE GENITAL 2008 CMS RBRVS (0000000) 115.315%SURGERY - MATERNITY & DELIVERY 2008 OMS RBRVS (0000000) 133.536%SURGERY - ENDOCRINE 2008 OMS RBRVS (0000000) 122.194%SURGERY - NERVOUS 2008 OMS RBRVS (0000000) 129.939%SURGERY - EYE & OCULAR ADNEXA 2008 OMS RBRVS (0000000) 126.264%SURGERY - AUDITORY 2008 OMS RBRVS (0000000) 124.189%RADIOLOGY 2008 OMS RBRVS (0000000) 74.619%RADIOLOGY - BONE DENSITY 2008 OMS RBRVS (0000000) 72.649%RADIOLOGY - CT 2008 OMS RBRVS (0000000) 74.619%RADIOLOGY - MAMMOGRAPHY 2008 OMS RBRVS (0000000) 74.619%RADIOLOGY - MRI 2008 CMS' RBRVS (0000000) 74.619%RADIOLOGY - MRA 2008 OMS RBRVS (0000000) 74.619%RADIOLOGY - NUCLEAR MEDICINE 2008 OMS RBRVS (0000000) 74.619%RADIOLOGY - PET SCANS 2008 OMS RBRVS (0000000) 74.619%RADIATION THERAPY 2008 OMS RBRVS (0000000) 74.619%RADIOLOGY - ULTRASOUND 2008 CMS RBRVS (0000000) 74.619%LAB - PATHOLOGY 2008 OMS RBRVS (0000000) 59.705%OFFICE LAS3 2008 CMS Clinical Lab Schedule - Nationat Limit 60.000%CLINICAL LABORATORY 2008 OMS Clinical Lab Schedule National Limit 42.000%MEDICINE - OPHTHALMOLOGY 2008 OMS RBRVS (0000000) 105.364%MEDICINE - CARDIOVASCULAR 2008 OMS RBRVS (0000000) 126.972%MEDICINE - ALLERGY & CLINICAL IMMUNOLOGY 2008 OMS RBRVS (0000000) 123.087%MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT 2008 CMS RBRVS (0000000) 119.805%MEDICINE - MODALITIES, THERAPIES 2008 OMS RBRVS (0000000) 120.986%MEDICINE - OTHER 2008 OMS RBRVS (0000000) 121.38%MEDICINE - CHEMO ADMIN 2008 CMS RBRVS (0000000) 156.615%OBSTETRICS - GLOBAL 2008 OMS RBRVS (0000000) 159.398%IMMUNIZATIONS Redbook J Code-CPT Code AWP 100.000%INJECTABLES/OTHER DRUGS OMS Drug Pricing 100.000%INJECTABLES ONCOLOGYTTHERAPEUTIC CREMO DRUGS OMS Drug Pricing 106.000%INJECTABLES - IVIG OMS Drug Pricing 100.000%INJECTABLES-SALINE & DEXTROSE SOLUTIONS CMS Drug Pricing 100.000%DME & SUPPLIES 2008 OMS DME Ceiling 75.000%DME & SUPPLIES RESPIRATORY 2008 OMS DME Ceiling 75.000%DME & SUPPLIES - ORTHOTICS 2008 OMS DME Ceiling 75.000%DME & SUPPLIES - PROSTHETICS 2008 OMS DME Ceiling 75.000%AMBULANCE 2008 CMS Ambulance Schedule Urban (0000000) 100.000%Hard Codes


Additional Information About Your Fee ScheduleCA 6218

The purpose of this document is to provide additional information about this fee schedule, including clarity about the fee sources used to derive feesand the type of routine maintenance changes that you can expect.

Primary Fee SourceThe primary fee source is the main fee source used as the basis for deriving the fee within each category of codes. For instance, if the fee schedule fora given category of codes is derived by applying a particular conversion factorto the relative value units (RVUs) in the CMS fee schedule, thoseCMS relative value units are the primary fee source.

Alternate (Gap-Fill) Fee SourceAlternate (or "gap fill") fee sources are used to fill gaps in the primary fee sources. For example, if a new CPT code has been createdwithin thecategory of codes discussed above, and CMS has not yet established an R'VU value for that code, we use one of the sources that exist within theindustry to fill that gap, such as but not limited to Ingenix Essential RBRVS. For that CPT code, we adopt the RVU value establishedby the gapfill-fee source, and determine the fee schedule amount for that CPT code by applying to the gap-fill RVU the same conversion factor that we apply tothe CMS RVU for those CPT codes that have CMS RVUs. At such time in the future as CMS publishes its own RVU value for that CPT code, wewould begin using the primary fee source, CMS, to derive the fee for that code and no longer use the alternate source.

Percent of Charge DefaultIn the event that a fee is not sourced by either the primary or alternate fee source, such as services submitted using unclassified or miscellaneouscodes, the codes are subject to correct coding review and may be priced at the default Percent of Charge indicated in the attached doeument(s).

Fee Source LinksCMS Relative Values and Fee Schedules: www.cms.hhs.gov

MICROMEDEX Red Book: www.micromedex.comRJ Health Systems: www.reimbursementcodes.com

Ingenix Essential RBRVS: www.ingenixonline.com

American Society of Anestliesiologists: www.asahq.org

Site of ServiceThis fee schedule generally follows CMS guidelines for determining when services are priced at the Facility or Nonfacility fee schedule (with theexception of services performed at Ambulatory Surgery Centers, POS 24, which will be priced at the Facility fee schedule). CMS guidelines can belocated at the website indicated above.

Routine MaintenanceUnited routinely updates its fee schedule in an effort to stay abreast of current coding practices widely used in the health care industry; in response toprice changes for immunizations and injectable medications; and to remain in compliance with the intent of the contractual agreement. Routinemaintenance occurs when United mechanically incorporates revised information createdby a third party that is the source for a portion of the feeschedule. United will not generally attempt to communicate routine maintenance ofthis nature and will generally implement updates to be effectivewithin 90 days from the date of final publication from one of our primary or alternate fee sources. Providers may expect the following types of feeupdates to their fee schedules:

a. Changes to Relative Value Units, Conversion Factors, or Flat Rate FeesThis fee schedule follows a "Stated Year" construction methodology. It is generally intended to lock in to the 2008 RVU, the January 2008Conversion Factor, and the 2008 Flat Rate Fees (non-RVU based fees such as Durable Medical Equipment fees) as the basis for deriving fees.

Unless specifically indicated otherwise, amounts listed M the fee schedule represent global fees andmay be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under thecustomer's benefit contract will be subtracted from the listed amount M determining the amount tobe paid by the payer. The actual payment amount is also subject to matters described in this agreement, suchas the payment policies. Please remember that this information is subject to theconfidentiality provisions of this agreement.

" Note: Maintenance to this fee schedule occurs routinely and may still occur after the report date for the fee amounts selected.


UnitedHealthcare

Page 5

UnitedHealthcare®A UnitedHealth Group Company


Generally, any RVU, Conversion Factor, or Flat Rate Fee changes published in subsequent years by the primary and/or alternate fee sources willnot be reflected in this fee schedule.

Price Changes for Immunizations and Injectable MedicationsUnited routinely updates its fee schedule in response to price changes for immunizations and injectable medications published by the primaryand/or alternate fee sources. United currently utilizes CMS Drug Pricing andThomson Micromedex Red Book AWP as its primary fee sources.The effective date of fee updates under this subsection b will beno later than the first day of the next calendar quarter after final publication by thefee source, except that if that quarter begins less than 60 days after final publication, the effective date will be no later than the first day of the nextcalendar quarter. For example, if final publication by the fee source is on April 10, the fee update under this subsection b will be effective no laterthan July 1, and if final publication by the fee source is on June 10, the fee update under this subsection c will be effective no later than October I.For purposes of this paragraph, the date of a claim is the date of service.

CPT/HCPCS Changes and Other Ongoing UpdatesUnited routinely updates its fee schedule in response to additions, deletions, and changes to CPT codes by the American Medical Association;HCPCS codes by the Centers for Medicaid and Medicare Services; CMS changes to its annual update; and in response to similar changes(additions and revisions) to other service coding and reporting conventions thatare widely used in the health care industry. Ordinarily, United's feeschedule is updated using the original construction methodology along with the then-current RVU of the published CPT code. The effective date offee updates under this subsection c will be no later than the first day of the next calendar quarter after final publication by the fee source, exceptthat if that quarter begins less than 60 days after final publication, the effective date will heno later than the first day of the next calendar quarter.For example, if final publication by the fee source is on April 10, the fee update under this subsection c will be effective no later than July .1, and iffinal publication by the fee source is on June 10, the fee update under this subsection c will be effective no later than October 1. For purposes ofthis paragraph, the date of a claim is the date of service.

United is committed to providing transparency related to our fee schedules. Ifyou have questions about this fee schedule, please contact NetworkManagement at the address and phone number on your network participation agreement or you may use our fee schedule look-up function on the webat www.unitedhealthcareonline.com or contact our Voice Enabled Telephonic Self Service line at (877) 842-3210,

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professionaland technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining theamount tobe paid by the payer. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. Please remember that this information is subjectlo theconfidentiality provisions of this agreement.

* Note: Maintenance to this fee schedule occurs routinely and may still occur after the report date for the fee amounts selected.


Page 6

COVER PAGE TO MEDICAL GROUP CONTRACT

Please note regarding California:

The attached Medical Group Contract is a contract by and between United HealthCare InsuranceCompany, on behalf of itself and its affiliates, and you and your professional staff. PacifiCare ofCalifornia (a United Affiliate and a California licensed healthcare service plan) is also a party to thisagreement. When you provide services to a PacifiCare of California member and those services aresubject to this agreement, all references to "United" or "us" in this agreement, in connection with thoseservices, mean PacifiCare of California. PacifiCare of California is not responsible for services youprovide to our members who are not PacifiCare of California members.

This agreement includes a California Regulatory Requirements Appendix. If there is any inconsistencybetween the California Regulatory Requirements Appendix and any term or condition contained in theagreement, the terms of the California Regulatory Requirements Appendix will control, except withregard to benefit contracts outside the scope of the California Regulatory Requirements Appendix.

If you have any questions regarding this agreement you may contact us at (888) 291-0404.

This Cover Page shall be deemed a part of the Agreement.

UNITEDHEALTHCARE UHC/SMGA.02.06.CA Confidential and Proprietary Page 1 of 18

INTRODUCTION

Our agreement consists of this contract, the appendices, and the additional materials we reference in theattached Appendix 1.

Guiding principles

We strive to operate in accordance with the following principles:We want to work together with America's best physicians to improve the health care

experience of our customers.

We respect and support the physician/patient relationship while adhering fairly to thecontract for benefits we provide our customers.

Whether a particular treatment is covered under a benefit contract should not determineif the treatment is provided. Physicians and health care professionals should provide thecare they believe is necessary regardless of coverage.

You should discuss treatment options with patients regardless of coverage. Weencourage that communication.

Physicians should describe any factors that could affect their ability to renderappropriate care. Matters such as professional training, financial incentives, availabilityconstraints, religious or philosophical beliefs, and similar matters are all things that aphysician should consider discussing with a patient. We encourage these communications.We urge full disclosure.

Fairness and efficiency will govern the ways in which we administer our products. Wewill make our determinations promptly. Our commitments to our customers will be clear. Wewill honor our agreements. When it comes to coverage determinations, the language of thebenefit contract will take precedence.

Next steps

Please read this agreement. If you have questions, write to or call:

Network Management5757 Plaza Drive

Mail Stop CAl24-0115

Cypress, CA 90630(888) 291-0404

You can visit our websites at www.unitedhealthcareonline.com (UnitedHealthcare Onlinee) and atwww.pacifiCare.com for additional details on items described in the agreement. If the agreement is

acceptable to you, please sign both of the enclosed copies of the contract, and send both copies to theaddress above.


MEDICAL GROUP CONTRACT

United HealthCare Insurance Company and PacifiCare of California are entering into this agreement withyou. They are doing so on behalf of themselves and their other affiliates for certain products and serviceswe offer our customers, all of which we describe in the attached Appendix 2.

This agreement applies to you and to your professional staff (the physicians and other professionals whoare your employees, or your independent contractors providing services to your patients, and who aresubject to credentialing by us) and the services you provide. When this agreement refers to "you", it alsorefers to your professional staff. Your professional staff is bound to the same requirements of thisagreement as you are. You represent to us that you have the authority to bind your professional staff tothis agreement.

What vou will do

You need to be credentialed in accordance with our Credentialing Plan, as referenced in Appendix 1, forthe duration of this agreement.

You must notify us in a timely manner about certain services you provide in accordance with ourAdministrative Guide so that we can provide our customers with the services we have committed toprovide. If you do not so notify us about these services, you will not be reimbursed for the services, andyou may not charge our customer.

Within one year of the effective date of this agreement, you must conduct business with us entirely on anelectronic basis to the extent that we are able to conduct business electronically (described in theAdministrative Guide), including but not limited to determining whether your patient is currently acustomer, verifying the customer's benefit, and submitting your claim. We will communicateenhancements in UnitedHealthcare Online® functionality as they become available and will makeinformation available to you as to which products are supported by UnitedHealthcare Online.

You must submit your claims within 90 days of the date of service. After we receive your claim, if werequest additional information in order to process your claim, you must submit this additional informationwithin 90 days of our request. If your claim or the additional information is not submitted within thesetimeframes, you will not be reimbursed for the services, and you may not charge our customer.

You will submit claims only for services performed by you or your staff. Pass through billing is notpayable under this agreement and may not be billed to our customer. For laboratory services, you willonly be reimbursed for the services that you are certified through the Clinical Laboratory ImprovementAmendments (CLIA) to perform, and you must not bill our customers for laboratory services for whichyou are not certified.

You will submit claims that supply all applicable information. These claims are complete claims. Furtherinformation about complete claims is provided in our Administrative Guide.

If you disagree with our payment determination on a claim, you may submit an appeal as described in our

Administrative Guide.

UN1TEDHEALTHCARE UHC/SMGA.02.06.CA Confidential and Proprietary Page 3 of 18

You will not charge our customers anything for the services you provide, if those services are coveredservices under their benefit contract, but the applicable co-pay, coinsurance or deductible amount. If theservices you provide are denied or otherwise not paid due to your failure to notify us, to file a timelyclaim, to submit a complete claim, to respond to our request for information, or based on ourreimbursement policies and methodologies, you may not charge our customer. If the services you provideare denied for reason of not being medically necessary, you may not charge our customer unless ourcustomer has, with lcnowledge of our determination of a lack of medical necessity, agreed in writing to beresponsible for payment of those charges. If the services you provide are not covered under ourcustomer's benefit contract, you may, of course, bill our customer directly. You will not require acustomer to pay a "membership fee" or other fee in order to access you for covered services (except forco-payments, coinsurance and/or deductibles provided for under the customer'sbenefit contract) and willnot discriminate against any customer based on the failure to pay such a fee.

You will cooperate with our reasonable requests to provide information that we need. We may need thisinformation to perform our obligations under this agreement, under our programs and agreements withour customers, or as required by regulatory or accreditation agencies.

You will refer customers only to other network physicians and providers, except as permitted under ourcustomer's benefit contract, or as otherwise authorized by us or the participating entity.

What we will do

We or the other applicable participating entity will promptly adjudicate and pay your complete claim forservices covered by our customer's benefit contract. If you submit claims that are not complete,

You may be asked for additional information so that your claim may be adjudicated; or

Your claim may be denied and you will be notified of the denial and the reason for it; or

We may in our discretion attempt to complete the claim and have it paid by us or theother applicable participating entity based on the information that you gave in addition to theinformation we have.

If governing law requires us to pay interest or another penalty for a failure to pay your complete claim forcovered services within a certain time frame, we will follow those requirements. The interest or otherpenalty required by law will be the only additional obligation for not satisfying in a timely manner apayment obligation to you. In addition, if we completed a claim of yours that was not complete, thereshall be no interest or other late payment obligation to you even if we subsequently adjust the paymentamount based on additional information that you provide.

The applicable participating entity will reimburse you for the services you deliver that our customer'sbenefit contract covers. The amount you receive will be based on the lesser of your billed charges or ourfee schedule, which is described at Appendix 1 and is subject to the reimbursement (coding) policies andmethodologies of us and the participating entities. Our reimbursement policies and methodologies areupdated periodically and will be made available to you online or upon request To request a copy of ourreimbursement policies and methodologies, write to Network Management, 5757 Plaza Drive, Mail StopCAl24-0115, Cypress, CA 90630. Your reimbursement is also subject to our rules concerning retroactiveeligibility, subrogation and coordination of benefits (as described in the Administrative Guide). We


recognize CPT reporting guidelines as developed by the American Medical Association, as well as ICDdiagnostic codes and hospital-based revenue codes. Following these guidelines does not imply a right toreimbursement for all services as coded or reported.

Ordinarily, fee amounts listed in Appendix 3 are based upon primary fee sources. We reserve the right touse gap-fill fee sources where primary fee sources are not available.

We routinely update our fee schedule in response to additions, deletions and changes to CPT codes by theAmerican Medical Association, price changes for immunizations and injectable medications, and inresponse to similar changes (additions and revisions) to other service coding and reporting conventionsthat are widely used in the health care industry, such as those maintained by the Centers for Medicaid andMedicare Services (for example HCPCS, etc.). Ordinarily, our fee schedule is updated using similarmethodologies for similar services. We will not generally attempt to communicate routine maintenance ofthis nature and will generally implement updates within 90 days from the date of publication.

We will give you 90 days written or electronic notice of non-routine fee schedule changes which willsubstantially alter the overall methodology or reimbursement level of the fee schedule. In the event suchchanges will reduce your overall reimbursement under this Agreement, you may terminate thisAgreement by giving 60 days written notice to us, provided that the notice is given by you within 30 daysafter the notice of the fee schedule change.

If either of us believes that a claim has not been paid correctly, either of us may seek correction of thepayment within a 12-month period following the date the claim was paid, except that overpayments as aresult of abusive or fraudulent billing practices may be pursued by us beyond the 12-month time framementioned above. In the event of an overpayment, we will correct these errors by adjusting future claimpayment and/or by billing you for the amount of the overpayment.

Your professional staff

You represent to us that all of the members of your professional staff, as of the date you executed thisagreement, are listed in Appendix 4. All of the members of your professional staff will participate in ournetwork through this agreement, except in cases in which one of your professional staff is not acceptedfor participation or is removed from participation under our credentialing program, or removed fromparticipation by us immediately due to that professional being sanctioned by any governmental agency orauthority (including Medicare or Medicaid), or having lost a license to provide all or some of theprofessional services under this agreement, or no longer having hospital admitting privileges in anyparticipating hospital. Your professional staff will cooperate with our credentialing program.

If a new professional joins your professional staff, you will give us 60 days notice and provide theinformation included in Appendix 4. You will assure that the new professional will promptly submit acredentialing application to us (unless the new professional is already credentialed with us) and cooperatewith our credentialing program.

You will assure that a member of your professional staff who has not been approved or is not in goodstanding under our credentialing program will not provide covered services to our customers. In the eventthat professional does provide covered services, you will not bill us, our customer, or anyone acting onour customer's behalf for the service, and you will assure that the professional also does not bill for theservice.

If a professional leaves your professional staff, you will notify us within ten business days after youbecome aware that the professional will leave. The notice will include the date that the professional willdepart from your professional staff. If you lmow the future contact information for the professional and


whether the professional will continue to practice after leaving your professional staff, you will makereasonable commercial efforts to include that information in the notice and will provide that informationto us if we request it.

How long our agreement lasts; how it gets amended; and how it can end

Assuming you are credentialed by us, and we execute this agreement, you will receive a copy from uswith the effective date noted below the signature block. It continues until one of us terminates it.

We can amend this agreement or any of the appendices on 90 days written or electronic notice by sendingyou a copy of the amendment. Your signature is not required to make the amendment effective. However,if you do not wish to continue your participation with our network as changed by an amendment that isnot required by law or regulation but that includes a material adverse change to this agreement, then youmay terminate this agreement on 60 days written notice to us so long as you send this termination noticewithin 30 days of your receipt of the amendment.

In addition, either you or we can terminate this agreement, effective on an anniversary of the date thisagreement begins, by providing at least 90 days prior written or electronic notice. Either you or we canterminate this agreement at any time if the other party has materially breached this agreement, byproviding 60 days written notice, except that if the breach is cured before our agreement ends, theagreement will continue.

Either of us can immediately terminate this agreement if the °tiler becomes insolvent or has bankruptcyproceedings initiated.

Finally, we can immediately terminate this agreement if any governmental agency or authority (includingMedicare or Medicaid) sanctions you.

We both agree that termination notices under this agreement must be sent by certified mail, return receiptrequested, to Network Management, 5757 Plaza Drive, Mail Stop CAl24-0115, Cypress, CA 90630 or tothe post office address you provided us. We both will treat termination notices as "received" on the thirdbusiness day after they are sent.

About data and confidentiality

We agree that your medical records do not belong to us. You agree the information contained in theclaims you submit is ours. We both will protect the confidentiality of our customers' information inaccordance with applicable state and federal laws, rules, and regulations.

We are both prohibited from disclosing to third parties any fee schedule or rate information. There arethree exceptions:

You can disclose to our customer information relating to our payment methodology fora service the customer is considering (e.g., global fee, fee for service), but not specific rates(unless for purposes of benefit administration).

We and the participating entities may use this information to administer our customers'benefit contracts and to pay your claims. We also may permit access to information byauditors and other consultants who need the information to perform their duties, subject to aconfidentiality agreement.


We both may produce this information in response to a court order, subpoena orregulatory requirement to do so, provided that we use reasonable efforts to seek to maintainconfidential treatment for the information.

What if we do not a2ree

We will resolve all disputes between us by following the dispute procedures set out in our AdministrativeGuide. If either of us wishes to pursue the dispute beyond those procedures, they will submit the disputeto binding arbitration in accordance with the Commercial Dispute Procedures of the American ArbitrationAssociation (see http://www.adr.org) within one year.

We both expressly intend that any dispute between us be resolved on an individual basis so that no otherdispute with any third party(ies) may be consolidated or joined with our dispute. We both agree that anyarbitration ruling by an arbitrator allowing class action arbitration or requiring consolidated arbitrationinvolving any third party(ies) would be contrary to our intent and would require immediate judicialreview of such ruling. The arbitrator will not vary the terms of this agreement and will be bound bygoverning law. We both acknowledge that this agreement involves interstate commerce, and is governedby the Federal Arbitration Act, 9 U.S.C. § 1 et seq. The arbitrator will not have the authority to awardpunitive or exemplary damages against either of us, except in connection with a statutory claim thatexplicitly provides for such relief. Arbitration will be conducted in San Francisco County, CA.

If a court allows any litigation of a dispute to go forward, we both waive rights to a trial by jury withrespect to that litigation, and the judge will be the finder of fact. Any provision of this agreement that isinvalid or unenforceable shall not affect the validity or enforceability of the remaining provisions of thisagreement or the validity or enforceability of the offending provision in any other situation or in any otherjurisdiction. This section of the agreement shall survive and govern any termination of this agreement.

What is our relationship to one another

You are an independent contractor. This means we do not have an employer-employee, principal-agent,partnership, joint venture, or similar arrangement. It also means that you make independent health caretreatment decisions. We do not. We do not reserve any right to control those treatment decisions. Itfurther means that each of us is responsible for the costs, damages, claims, and liabilities that result fromour own acts.

You will look to the applicable participating entity for reimbursement for the products and services underour agreement. This means that we are not financially responsible for claims payment for groups that areself-funded or that are not affiliated with us.

We may assign this agreement to any entity that is an affiliate of United HealthCare Insurance Companyat the time of the assignment.


This is it

This contract, the appendices and the items referenced in the attached Appendix 1, constitute our entireunderstanding. It replaces any other agreements or understandings with regard to the same subject matter- - oral or written - - that you have with us or any of our affiliates.

Federal law and the applicable law of the jurisdiction where you provide health care services govern ouragreement. Such laws and the rules and regulations promulgated under them, when they are applicable,control and supersede our agreement. The Regulatory Appendix referenced in Appendix 1, and anyattachment to it, is expressly incorporated to govern our agreement and is binding on both of us. In theevent of any inconsistent or contrary language between the Regulatory Appendix (when it applies) andany other part of our agreement, including but not limited to appendices, amendments and exhibits, theRegulatory Appendix will control.


Appendix 1We include as part of our agreement the following additiona/ materials that bind you and us:

Appendix 2 Definitions, Products and ServicesThis appendix sets forth definitions for our "customer" and "participatingentities" as well as lists the type of benefit contracts offered to our customers.

Appendix 3 Fee Schedule Sample. This document includes a portion of our fee schedulefor the most frequent procedures you perform, or for those procedures you haverequested. Additional portions of the fee schedule can be requested bywriting to Network Management, 5757 Plaza Drive, Mail Stop CAl24-0115,Cypress, CA 90630.

Appendix 4 This document provides information about the members of your professionalstaff.

StateRegulatoryRequirementsAppendix

In some instances, states add requirements to our agreement that are set forth inthis appendix.

MedicareRegulatoryRequirementsAppendix

(This appendix applies only if you are in our Medicare network)Your participation in our network for customers with Medicare benefitcontracts is subject to additional Medicare requirements set forth in thisappendix

MedicarePaymentA pp endix

Th is appendix applies only if you are in our Medicare network.

AdministrativeGuide

We have enclosed a copy of our Administrative Guide. This guide governs themechanics of our relationship. Our Administrative Guide may be viewed bygoing to www.unitedhealthcareonline.com. Additionally, for customers enrolledin benefit plans issued or administered by a subsidiary of either PacifiCareHealth Plan Administrators, Inc. or PacifiCare Health Systems, LLC (thesecustomers are referred to as "PacifiCare Customers"), you will be subject torequirements described in or made available to you through the PacifiCareProvider Policy and Procedure Manual ("PacifiCare Manual"). When thisagreement refers to the Administrative Guide, it is also referring to thePacifiCare Manual. The PacifiCare Manual will be made available to you online or upon request. In the event of any conflict between this Medical GroupContract or the "UnitedHealthcare Physician, Health Care Professional, Facilityand Ancillary Provider Administrative Guide" or other UnitedHealthcareadministrative protocols, and the PacifiCare Manual, in connection with anymatter pertaining to a PacifiCare Customer, the PacifiCare Manual will govern,unless applicable statutes and regulations dictate otherwise. We may makechanges to the Administrative Guide or PacifiCare Manual or otheradministrative protocols upon 30 days' electronic or written notice to you.

CredentialingPlan

To review our credentialing plan, visit www.unitedhealthcareonline.com. Thisplan requires your professional staff to be covered by malpractice insurance inamounts with carriers and on terms and conditions that are customary forprofessionals like them in your community. To request access to, or a copy of,our credentialing plan, write to Network Management, 5757 Plaza Drive, MailStop CAl24-0115, Cypress, CA 90630.


Appendix 2Definitions, Products and Services

Customer. Individuals who are enrolled in benefit contracts instu-ed or administered by us or anyparticipating entity are included in our use of the phrase "customer" in this agreement.

Participating entities. The following entities have access to our agreement:

United HealthCare Insurance Company and its affiliates

Groups receiving administrative services from United HealthCare Insurance Company or itsaffiliates or that have arranged for network access through an entity that has contracted with UnitedHealthCare Insurance Company or one of its affiliates.3. Products and services. We may include you in networks where your patients are enrolled in benefitcontracts of the types generally described below:

Benefit contracts where individuals are offered a network of participating physicians and otherhealth care professionals and must select a primary care physician, who in some cases must approve anycare provided by other health care providers. An option for this benefit contract allows individuals toreceive health services from non-participating physicians.

Benefit contracts where individuals are offered a network of participating physicians and otherhealth care providers but are not required to select a primary care physician. An option for this benefitcontract allows individuals to receive health services from non-participating physicians.

Benefit contracts where individuals are not offered a network of participating physicians and otherhealth care providers.

Medicare benefit contracts that (A) are sponsored, issued or administered by us or another applicableparticipating entity and (B) replace, either partially or in its entirety, the traditional Medicare coverage(Medicare Part A and Medicare Part B) issued to beneficiaries by the Centers for Medicare and MedicaidServices ("CMS"), other than Medicare Advantage Private Fee-For-Service Plans.

However, this agreement does not apply to the following:

Knox-Keene capitation arrangements. Knox-Keene capitation arrangements are when all of thefollowing apply:

(i) You (directly or through an IPA or other provider organization in which you participate) are partof a network for one of our affiliates; and(ii) As part of that network, you arrange directly with our affiliate, or an IPA, or another medicalgroup or other provider organization, for certain designated services to be provided to members who areassigned to you or to the IPA or the other medical group or other provider organization (as the case maybe) and who are covered under benefit contracts subject to the Knox-Keene Act; and under which either:

You are capitated or otherwise have financial responsibility; orYou are paid on a fee for service basis directly by the IPA, other medical group or other provider

organization that has financial responsibility for the service, at a rate you have agreed upon with the IPAor other medical group or other provider organization; and(iii) You provide those designated services to one of those assigned members.

UNITEDHEALTHCARE UHC/SMGA.02.06.CA Confidentiai and Proprietary Page 11 of 18

In such cases, the obligation for payment will be solely that of the TPA, medical group or other providerorganization that has financial responsibility for the service, and not ours or our affiliate's.

Benefit contracts for Medicaid customers. Note: Although Medicaid benefit contracts are excludedfrom this agreement, there can be a separate agreement between us or between our and your affiliates orother entity authorized to contract on behalf of you (such as an IPA agreement) providing for yourparticipation in a network for those benefit contracts.

Medicare Advantage Private Fee-For-Service Plans.

Benefit contracts for workers' compensation benefit programs.

Benefit contracts for Medicare Select.


Appendix 3Fee Schedule Sample: Options PPO

Representative Options PPO Fee Schedule Sample for : CA 6250 and CA 6251

The provisions of this appendix apply to covered services rendered by you to customers covered bybenefit contracts marketed under the name "Options PPO". This appendix does not apply to coveredservices rendered by you to customers covered by benefit contracts sponsored, issued or administered byPacifiCare Health Plan Administrators, Inc. or PacifiCare Health Systems, LLC or by one of theirsubsidiaries.

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and maybe subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under thecustomer's benefit contract will be subtracted from the listed amount in determining the amount to bepaid by us or the participating entity. The actual payment amount is also subject to matters described inthis agreement, such as the reimbursement policies. Please remember that this information is subject tothe confidentiality provisions of this agreement.


Appendix 3Fee Schedule Sample: Products other than Options PPO

Representative All Payer Fee Schedule Sample for: CA 6212 and CA 6213

Unless another appendix to this agreement applies specifically to a particular benefit contract as it coversa particular customer, the provisions of this appendix apply to covered services rendered by you tocustomers covered by benefit contracts sponsored, issued or administered by all participating entities.

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and maybe subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under thecustomer's benefit contract will be subtracted from the listed amount in determining the amount to bepaid by us or the participating entity. The actual payment amount is also subject to matters described inthis agreement, such as the reimbursement policies. Please remember that this information is subject tothe confidentiality provisions of this agreement.


Appendix 3

Representative Medicare Fee Schedule Sample: CA 7205 and CA 7206

The provisions of this appendix apply to services rendered by you to our Medicare customers covered by Medicarebenefit contracts that are (A) are sponsored, issued or administered by us or another applicable participating entityand (B) replace, either partially or in its entirety, the original Medicare coverage (Medicare Part A and MedicarePart B) issued to beneficiaries by CMS, other than Medicare Advantage Private Fee-For-Service Plans. Theprovisions of this appendix do not apply to services you render to Medicare beneficiaries pursuant to a commercialbenefit contract. This fee schedule does not apply to any other Medicare product or any dual eligible benefitcontract.

We will use our best efforts to update the amounts for services listed in the attached fee schedule that are based onthe CMS physician Medicare fee schedule on or before the later of (a) ninety (90) days after the effective date of anymodification made by CMS to the CMS physician Medicare fee schedule; provided, however, in the event CMSmakes a change to such modification after the effective date of such modification, we will use our best efforts toupdate the methodology and factors in accordance with such subsequent change within ninety (90) days after thedate on which CMS places information regarding such subsequent change in the public domain, or (b) ninety (90)days after the date on which CMS initially place information regarding such modification in the public domain (e g,CMS distributes program memoranda to providers).

Amounts listed in the attached sample fee schedule are gross amounts. Any co-payments, deductibles or coinsurancethat our Medicare customer is responsible to pay under his or her benefit contract will be subtracted from the amountlisted in the attached sample fee schedule in determining the amount to be paid by us or by a participating entity.The actual payment amount is also subject to matters described in our agreement, including our reimbursementpolicies


Appendix 4- LOCATIONS

Please remember that, as described on page 2, this agreement applies to all of your locations even if you do not list

all of your current locations or if you add a location in the filture.

Primary ServiceLocation Address:

Address: P.O. Box 2739

City: Ukiah State: CA Zip: 95482Tel #: Fax #:

Billing Address: Address: SAMECity: State: Zip:

Tel #: Fax #:

Secondary ServiceLocation Address:

Address:

City: State: Zip:Tel #: Fax #:

Billing Address:

Same as

Address:City: State: Zip:

aboveTel #: Fax #:

Mailing Address: Address:City: State: Zip:

Tel #: Fax #:


Provider: Ukiah Valley Primary Care Medical TIN: 680345883

Group

PHY

SIC

IAN

RO

STE

R

Nam

e of

Prov

ider

Deg

ree

Mal

eO

rFe

mal

e

Prov

ider

Spec

ialty

(ie

s)C

A S

tate

Lic

ense

UPI

N #

Fore

ign

Lan

guag

e (s

)A

dmitt

ing

Hos

pita

ls

The

ron

Cha

nM

DM

ale

Fam

ily P

ract

ice

G36

292

A46

636

,i-ro

f-.

.5

Uki

ah V

alle

y M

ed. C

tr.

Lyn

ne C

oen

MD

Fem

ale

Fam

ily P

ract

ice

G46

525

C99

289

,i---

xt-

t.Th

Uki

ah V

alle

y M

ed. C

tr.

Tri

enek

e K

ylst

raM

DFe

mal

eFa

mily

Pra

ctic

eA

6511

0U

kiah

Val

ley

Med

. Ctr

.L

aura

Wed

derb

umM

DFe

mal

eIn

tern

al M

edic

ine

A74

957

1140

050

Uki

ah V

alle

y M

ed. C

tr.

Mic

hael

H. T

urne

rM

DM

ale

Inte

rnal

Med

icin

eA

4415

5E

3415

0U

kiah

Val

ley

Med

. Ctr

.G

uy T

eran

MD

Mal

eIn

tern

al M

edic

ine

A53

014

G14

993

-4.-

-, N

4,-.

...U

kiah

Val

ley

Med

. Ctr

.Iy

ad H

anna

MD

Mal

eIn

tern

al M

edic

ine

A99

630

Uki

ah V

alle

y M

ed. C

tr.

Rus

sell

I. H

ardy

MD

Mal

eO

ncol

ogy

G59

375

E90

088

Uki

ah V

alle

y M

ed. C

tr.

Rob

ert B

. Cal

son

MD

Mal

eA

llerg

yA

2343

7A

2354

1U

kiah

Val

ley

Med

. Ctr

.Je

rem

y M

ann

MD

Mal

ePe

diat

rics

G54

839

A52

803

Uki

ah V

alle

y M

ed. C

tr.

Sam

uel G

oldb

erg

MD

Mal

ePe

diat

rics

G43

140

A49

249

Uki

ah V

alle

y M

ed. C

tr.

Sidn

ey M

aure

rM

DM

ale

Pedi

atri

csC

2319

2A

3233

4U

kiah

Val

ley

Med

. Ctr

.Pa

ul H

. Mac

dona

ldM

DM

ale

Pedi

atri

csA

6467

8O

TH

000

,/-

-fii-

ir.4

, Uki

ah V

alle

y M

ed. C

tr.

Gea

ta R

agup

aran

MD

Fem

ale

Pedi

atri

csA

9884

01-

1---

inU

kiah

Val

ley

Med

. Ctr

.K

irst

en W

hela

nM

DFe

mal

ePe

diat

rics

A06

7729

OT

H00

0U

kiah

Val

ley

Med

. Ctr

.Fr

edri

ck B

urri

sM

DM

ale

Gen

eral

Sur

gery

C33

796

A35

383

Uki

ah V

alle

y M

ed. C

tr.

Zia

d H

ama

DO

Mal

eG

ener

al S

urge

ry20

A95

48U

kiah

Val

ley

Med

. Ctr

.C

arl H

enni

ngM

DM

ale

Ort

hope

dics

G10

081

A37

843

Uki

ah V

alle

y M

ed. C

tr.

Paul

Jep

son

MD

Mal

eU

rolo

gyA

2335

2A

2349

7U

kiah

Val

ley

Med

. Ctr

.Pa

tric

ia C

aban

iss

MD

Fem

ale

OB

GY

NG

6453

5U

kiah

Val

ley

Med

. Ctr

.W

illia

m H

oom

alu

Jr.

PTM

ale

Phys

ical

The

rapy

PT59

73O

TH

000

Uki

ah V

alle

y M

ed. C

tr. I

Insert MSPS Here

UNITEDHEALTHC ARE UHC/SMGA.02.06.CA Confidential and Proprietary Page 17 of 18

CA 6250

UnitedHealth NetworksIsA UnitedHealth Group Company

Ukiah Valley Primary Care Medical Group68-0345883

Market Standard SpecificationsCalifornia Market(s)Specifications as of:0110112008

Report Date:0112412003*

Pago 1

EVALUATION & MANAGEMENT Current Year CMS RVU (0000000) $45.29

EVALUATION & MANAGEMENT - NEONATAL Current Year CMS RVU (0000000) $45.40

EVALUATION & MANAGEMENT- PREVENTIVE Current Year CMS RVU (0000000) $43.96

SURGERY - INTEGUMENTARY Current Year CMS RVU (0000000) $43.58

SURGERY - MUSCULOSKELETAL Current Year CMS RVU (0000000) $47.49SURGERY - RESP)FtATORY Current Year CMS RVU (0000000) $43.51SURGERY - CARDIOVASCUIAR Current Year CMS RVU (0000000) $49.19

SURGERY - HEMIC & LYMPHATIC Current Year CMS RVU (0000000) $42.26SURGERY - MEDIASTINUM á DIAPHRAGM Current Year CMS RVU (0000000) $50.21

SURGERY - DIGESTIVE Current Year CMS RVU (0000000) $48.17SURGERY - URINARY Current Year CMS RVU (0000000) $52.90SURGERY - MALE GENITAL Current Year CMS RVU (0000000) $46.35SURGERY - FEMALE GENITAL Current Year CMS RVU (0000000) $42.52SURGERY - MATERNITY& DELIVERY Current Year OMS RVU (0000000) $49.23

SURGERY - ENDOCRINE Current Year CMS RVU (0000000) $45.06

SURGERY NEFtVOUS Current Year CMS RVU (0000000) $47.94SURGERY - EYE & OCULAR ADNEXA Current Year CMS RVIJ (0009000) $46.54SURGERY - AUDITORY Current Year CMS FtVU (0000000) $45.78

FtADIOLOGY Current Year CMS RVU (0000000) $28.42

RADIOLOGY BONE DENSITY Current Year CMS RVU (0000000) $27.67

RADIOLOGY - CT Current Year CMS RVU (0000000) $28.42

RADIOLOGY - MAMMOGFLAPHY Current Year CMS RVU (0000000) $28.42RADIOLOGY - MRI Current Year CMS RVU (0000000) $28.42RADIOLOGY - MRA Current Year CMS RVU (0000000) $28.42RADIOLOGY - NUCLEAR MEDICINE Current Year CMS RVU (0000000) $28.42RADIOLOGY - PET SCANS Current Year CMS RVU (0000000) $28.42

RADIATION THERAPY Current Year CMS FtVU (0000000) $28.42

RADIOLOGY - ULTRASOUND Current Year CMS RVU (0000000) $28.42LAB - PATHOLOGY Current Year CMS RVU (0000000) $22.74OFFICE LAB Cunent Year CMS Clinical Lab Schedule National Limit 80.000WCLINICAL LABORATORY Current Year CMS Clinical Lab Schedule National Limit 4Z000%*MEDICINE - OPHTHALMOLOGY Current Year CMS RVU (0000000) $38.84MEDICINE - CARDIOVASCULAR Current Year CMS RVU (0000000) $46.80MEDICINE - ALLERGY & CLINICAL IMMUNOLOGY Current Year CMS RVU (0000000) $45.36MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT Current Year CMS RVU (0000000) $44.19MEDICINE - MODALITIES, THERAPIES Current Year CMS RVU (0000000) $44.81MEDICINE - OTHER Current Year CMS RVU (0000000) $44.76

MEDICINE CHEMO ADMIN Current Year CMS RVU (0000000) $57.76

OBSTETRICS GLOBAL Current Year CMS RVU (0000000) $58.78

IMMUNIZATIONS Redbook J Coda-CPT Code AWP 100.000W1NJECTABLES/OTHER DRUGS OMS Drug Pricing 100.000%*

INJECTABLES - ONCOLOGY/THERAPEUTIC CHEMO DRUGS OMS Drug Pricing 108.000%*

INJECTABLES - IVIG CMS Drug Pricing loamyINJECTABLES-SALINE & DEXTROSE SOLUTIONS CMS Drug Pricing 100.000%*

DME & SUPPLIES Current Year OMS DME Ceifing 75.000WDME & SUPPLIES - RESPIRATORY Current Year CMS OME Ceiling 75.000%*DME & SUPPLIES - ORTHOT1CS Current Year CMS DME Ceiling 75.000W

& SUPPLIES - PROSTHETICS Current Year CMS DME Ceiling 75.000W

AMBULANCE Current Year OMS Ambulance Schedule - Urban (0000000) 110.000%*

Hard Codes78459 -$1800.00 78478 $47.25 78480 -$47.25 78491 -$1800.00 78492 -$1800.00 78608- $1800.00 78809 -$1800.00 78811 $1800.00 78812 $1800.00 78813 -$1800.00 78814 -$1800.00 78815 - S1800.09 78816. $1800.00Default Percent of Charges: 50.00%CMS Modifier PricingSite of Service: Yes - CMS Assignment (ASC POS 24 ." F)Anesthesia Conversion Factor $ 59.40Anesthesia Rounding Option: ProrationSchedule Type: FFS

"Ali RVU and non-RVU based codes within these categories will be priced at the percent noted.

Unless specifically indicated othenvlse, amounts fisted In the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer Is responsible to pay under the customer's benefit contract will be subtracted from the listed amount In determining the amount tobe paid by the payer. 17re actual payment amount is also subject to matters descrkred in Ibis agreement, such as the payment policies. Please remember that this Information Is subjectto the



Site of Service Linked Schedule IDMarket MktStdID

CMScarrierlocality

California CA 6250 0000000 NonFac CA 6251


UnitedHealth NetworksA UnitedHealth Group Company


and/or alternate fee sources. United currently utilizes CMS Drug Pricing and Thomson Micromedex Red Book AWP as its primary fee sources.Fees are generally updated on a calendar quarter basis within 90 days from the date of final publication but with an effective date of the first day ofthe quarter following publication.

c. CPT/HCPCSUnited routinely updates its fee schedule in response to additions, deletions, and changes to CPT codes by the American Medical Association;HCPCS codes by the Centers for Medicaid and Medicare Services; and in response to similar changes (additions and revisions) to other servicecoding and reporting conventions that are widely used in the health care industry. Ordinarily, United's fee schedule is updated using the originalconstruction methodology along with the then-current RVU of the published CPT code.

United is committed to providing transparency related to our fee schedules. If you have questions about this fee schedule, please contact NetworkManagement at the address and phone number on your network participation agreement or you may use our fee schedule look-up function on the webat www.unitedhealthcareonline.com or contact our Voice Enabled Telephonic Self Service line at (877) 842-3210.

UnitedHealth NetworksPiA

UnitedHealth Group Company

Ukiah Valley Primary Care Medical GroupUnited Options PPO

Representative Fee Schedule Sample for : CA 6250Fee amounts as of:0110112008

Report Date:01/2412008



Unless specifically indicated othenvise. amounts Nsted in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deduclible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount tobe paid by the payer. The actual payment amount is also subject to matters described in Ibis agreement, such as the payment policies. Please remember that this inforrnation is subject to theconfidentiality provisions of this agreement.

Note: Maintenance to this fee schedule occurs roulineiy and may still occur after the report date ro, the fee amounts selected.


Page 1


45378 00 COLONOSCOPY FLEX SURGERY - DIGESTIVE NonFac $ 473.00


59400 00 ROUTINE OB CARE OBSTETRICS - GLOBAL NonFac $ 2625.07

59510 00 ROUTINE OB CARE OBSTETRICS - GLOBAL NonFac $ 2965.99

70553 00 MRI BRAIN; W/O T FtADIOLOGY MRI NonFac $ 769.13

70553 26 MR! BRAIN; W/O T FtADIOLOGY - MRI NonFac $ 84.42

70553 TC MR! BRAIN: W/O T RADIOLOGY - MRI NonFac S 684.71

78465 00 MYOCARD PERFUS I RADIOLOGY NUCLEAR MEDICINE NonFac S 399.63

78465 26 MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE NonFac S 54.86

78465 TC MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE NonFac S 344.77

88305 00 LEVEL IV - SURG LAB PATHOLOGY NonFac $ 61.62

88305 26 LEVEL IV - SURG LAB - PATHOLOGY NonFac $ 22.74

88305 TC LEVEL IV - SURG LAB - PATHOLOGY NonFac 938.8890471 00 IMMUNIZATION ADM MEDICINE - OTHER NonFac 9 22.83

90569 ao PNEUMOCOCCAL CON IMMUNIZATIONS NonFac $ 94.88

93000 00 ECG-ROUTINE 12 L MEDICINE OTHER NonFac $ 29.0993307 00 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac 9242.9193307 26 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac $ 58.03

93307 TC ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac S 184.8893325 00 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR NonFac $ 123.5693325 26 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR NonFac $ 4.6897110 co THERAP V> AREAS MEDICINE - OTHER NonFac $ 31.3397140 00 MNL TX TECH 1840 MEDICINE - OTHER NonFac 9 29.54

98940 00 CHIROPRACTIC MAN MEDICINE CHIROPRACTIC MANIPULATIVE TREATMENT NonFac $28.2898941 00 CHIROPRACTIC MAN MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT NonFac $ 38.8999202 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT NonFac $74.2799203 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT NonFac $ 110.05

99204 00 OFFICE OtJTPT NEW EVALUATION & MANAGEMENT NonFac $ 167.11

99205 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT NonFac $ 209.69

99212 00 OFC/OUTPT E&M ES EVALUATION & MANAGEMENT NonFac 9 43.9399213 00 OFC/OUTPT E&M ES EVALUATION á MANAGEMENT NonFac $ 71.1099214 00 OFC/OUTPT E&M ES EVALUATION & MANAGEMENT NonFac $ 107.79

99215 00 OFC/OUTPT E&M ES EVALUATION & MANAGEMENT NonFac $ 145.83

99223 00 INIT HOSP-DAY E& EVALUATION & MANAGEMENT NonFac $ 207.4299232 00 SUBSOT HSP-DAY E EVALUATION á MANAGEMENT NonFac 9 76.0999233 00 SUBSOT HOSP-DAY EVALUATION & MANAGEMENT NonFac $ 108.69

99243 00 OFFICE CNSLT NEW EVALUATION & MANAGEMENT NonFac $ 146.28

99244 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT NonFac $ 214.6699245 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT NonFac S 266.29

99283 00 EMERG DEPT VISIT EVALUATION & MANAGEMENT NonFac $ 72.46

99284 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT NonFac 9 131.78

99285 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT NonFac 9 197.45

99391 00 PRO PREV MED E&M EVALUATION 6 MANAGEMENT PREVENTIVE NonFac $ 85.28

99392 00 PRO PREV MED E&M EVALUATION & MANAGEMENT. PREVENTIVE NonFac $ 94.96

99393 00 PRO PREV MED E&M EVALUATION & MANAGEMENT PREVENTIVE NonFac $ 94.08

99394 00 PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE NonFac $ 103.31



J1745 00 INJECTION INFLIX INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS NonFac $ 58.52

J2505 oo INJECTION PEGFIL INJECTABLESONCOLOGY/THERAPEUTIC CHEMO DRUGS NonFac $ 2322.89

UnitedHealth Networks(J A UnitedHealth Group Company

Ukiah Valley Primary Care Medical GroupUnited Options PPO


Report Date:01/24/2008*Site of Service - Linked Schedule ID: CA 6250

Last Routine Maintenance Lfpdate: 01-01-2008Default Percent of Charges: 50.00%Anesthesia Conversion Factor: $ 59.40Anesthesia Rounding Option: Proration

Unless specifically indicated otherwIse, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount to

be paid by the payer. The actual payment amount in also subject to matters described in this agreement, such as the payment policies. Please remember that this information is subject to the


' Note: Maintenance to this fee schedule occurs routinely and may still occur after the report date for the lee amounts selected.


Page 1


45378 00 COLONOSCOPY FLEX SURGERY - DIGESTIVE Fac $ 249.99

45380 00 COLONOSCOPY FLEX SURGERY DIGESTIVE Fac 6 298.63

59400 00 ROUTINE OB CARE OBSTETRICS - GLOBAL Fac 6 2625.07

59510 00 ROUTINE OB CARE OBSTETRICS GLOBAL Fac 6 2965.99

70553 00 MRI BRAIN; WIO T RADIOLOGY MRI Fac $ 769.13

70553 26 MRI BRAIN; W/O T RADIOLOGY - MRI Fac $84.42

70553 TC MRI BRAIN; W/O T RADIOLOGY MRI Fac 6 684.71

78465 00 MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE Fac $ 399 63

78465 26 MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE Fac $ 54.86

78465 TC MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE Fac $ 344.77

88305 00 LEVEL IV - SURG LAB - PATHOLOGY Fac $ 61.62


88305 TC LEVEL IV - SURG LAB - PATHOLOGY Fac $38.88

90471 00 IMMUNIZATION ADM MEDICINE - OTHER Fac 6 22.83

90669 00 PNEUMOCOCCAL CON IMMUNIZATIONS Fac $ 94.88

93000 00 ECG-ROUTINE 12 L MEDICINE - OTHER Fac $ 29.09

93307 00 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR Fac $ 242.91


93307 TC ECHO TRNSTHOFtAC MEDICINE CARDIOVASCULAR Fac 6 184.88

93325 00 DOPPLR ECHO COLO MEDICINE CARDIOVASCULAR Fac $ 123.56

93325 26 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR Fat $ 4.68

97110 00 THERAP V> AREAS MEDICINE - OTHER Fac $ 31.33

97140 00 MNL TX TECH 1/M0 MEDICINE - OTHER Fac $ 29.54

98940 00 CHIROPRACTIC MAN MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT Fac $ 23.42

98941 00 CHIROPRACTIC MAN MEDICINE CHIROPRACTIC MANIPULATIVE TREATMENT Fac $ 33.58

99202 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT Fac $ 52.08



99205 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT Fac S 172.09

99212 00 OFC/OUTPT E&M ES EVALUATION & MANAGEMENT Fac $ 26.72




99223 00 INIT HOSP-DAY E& EVALUATION & MANAGEMENT Fac $ 207.42

99232 00 SUBSOT HSP-DAY E EVALUATION & MANAGEMENT Fac 6 76.09

99233 00 SUBSC/7 HOSP-DAY EVALUATION & MANAGEMENT Fac 5 108.69

99243 00 OFFICE CNSLT NEW EVALUATION & MANAGEMENT Fac $ 111.41

99244 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT Fac $ 174.36

99245 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT Fee $ 220.55

99283 00 EMERG DEPT VISIT EVALUATION & MANAGEMENT Fac $ 72.46

99284 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT Fac $ 131.78

99285 00 ER VISIT E&M HIG EVALUATION a MANAGEMENT Fac $ 197.45

99391 00 PRD PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac $ 57.59

99392 00 PRO PREV MED E&M EVALUATION & MANAGEMENT PREVENTIVE Fac $ 67.26

99393 00 PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac $ 67.26



99396 00 PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac $ 86.6/

J1745 00 INJECTION INFLIX INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS Fac $ 58.52

J2505 00 INJECTION PEGFIL INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS Fac $ 2322.89

CA 6212

Market Mkt CMS Site of Service Linked Schedule IDStd carrierID locality



Market Standard SpecificationsCalifornia Market(s)Specifications as of:01/01/2008


Page 1

EVALUATION & MANAGEMENT Current Year CMS RVU (0000000) $41.19EVALUATION & MANAGEMENT. NEONATAL Current Year CMS RVU (0000000) $41.31EVALUATION & MANAGEMENT PREVENTNE Current Year CMS RVU (0000000) $39.98SURGERY - INTEGUMENTARY Current Year CMS RVU (0000000) $39.64SURGERY - MUSCULOSKELETAL Current Year CMS RVU (0000000) $43.17SURGERY - RESPIRATORY Current Year CMS RVU (0000000) $39.53SURGERY - CARDIOVASCULAR Current Year CMS RVU (0000000) $44.72SURGERY HEMIC & LYMPHATIC Current Year CMS RVU (0000000) $38.43SURGERY MEDIASTINUM & DIAPHRAGM Current Year CMS RVU (0000000) $45.63SURGERY - DIGESTIVE Current Year CMS RVU (0000000) $43.81SURGERY - URINARY Current Year CMS RVU (0000000) $48.09SURGERY - MALE GENITAL Current Year CMS RVU (0000000) $42.14SURGERY - FEMALE GENITAL Current Year CMS RVU (0000000) $38.66SURGERY - MATERNITY & DELIVERY Current Year CMS RVU (0000000) $44.76SURGERY - ENDOCRINE Current Year CMS RVU (0000000) $40.97SURGERY - NERVOUS Current Year CMS RVU (0000000) $43.58SURGERY - EYE & OCULAR ADNEXA Current Year CMS RVU (0000000) $42.29SURGERY - AUDITORY Current Year CMS RVU (0000000) $41.65RADIOLOGY Current Year CMS RVU (0000000) $28.42RADIOLOGY - BONE DENSITY Current Year CMS RVU (0000000) $27.67RADIOLOGY CT Current Year CMS RVU (0000000) $28.42RADIOLOGY - MAMMOGRAPHY Current Year CMS RVU (0000000) $28.42RADIOLOGY MRI Current Year CMS RVU (0000000) $28.42FtADIOLOGY MRA Current Year CMS RVU (0000000) $28.42RADIOLOGY - NUCLEAR MEDICINE Current Year CMS RVU (0000000) $28.42FtADIOLOGY - PET SCANS Current Year CMS RVU (0000000) $28.42RADIATION THERAPY Current Year CMS FtVU (0000000) $28.42RADIOLOGY - ULTRASOUND Current Year CMS RVU (0000000) $28.42LAB - PATHOLOGY Current Year CMS RVU (0000000) $22.74OFFICE LAB Current Year CMS Clinical Lab Schedule - National Limit 60.000%*CLINICAL LABORATORY Current Year CMS Clinical Lab Schedule - National Limit 42.000WMEDICINE - OPHTHALMOLOGY Current Year CMS RVU (0000000) $35.32MEDICINE - CARDIOVASCULAR Current Year CMS RVU (0000000) $42.56MEDICINE ALLERGY & CLINICAL IMMUNOLOGY Current Year CMS RVU (0000000) $41.27MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT Current Year CMS RVU (0000000) $40.17MEDICINE - MODALITIES, THERAPIES Current Year CMS RVU (0000000) $40.55MEDICINE - OTHER Current Year CMS RVU (0000000) $40.70MEDICINE - CHEMO AMAIN Current Year CMS RVU (0000000) $52.49OBSTETRICS GLOBAL Current Year CMS RVU (0000000) $53.44IMMUNIZATIONS Redbook J Code-CPT Code AWP 1crosoomINJECTABLES/OTHER DRUGS CMS Drug Pricing 100.000%*INJECTABLES - ONCOLOGY/THERAPEUTIC CHEMO DRUGS CMS Drug Pricing 106.000%*INJECTABLES - IVIG CMS Drug Pricing 100.000WINJECTABLES-SALINE & DEXTROSE SOLUTIONS CMS Drug Pricing 100.000WDME & SUPPLIES Current Year CMS DME Ceiling 75.000WDME & SUPPLIES - RESPIRATORY Current Year CMS DME Ceiling 75.000WDME & SUPPLIES - ORTHOTICS Current Year CMS DME Ceiling 75.000%*DME & SUPPLIES PROSTHETICS Current Year CMS DME Ceiling 75.000%*AMBULANCE Current Year CMS Ambulance Schedule - Urban (0000000) 100.000%*

Hard Codes78459 -$1800.00 78478 -$47.25 78480 $47.25 78491 -$1800.00 78492 -$1800.00 78608 -$1800.60 78609 -$1800.00 78811 -$1800.00 78812 -$1800.00 78813 -$1800.00 78814 -$1800.00 78815 .$1800.00 78816 -$1800.00Default Percent of Charges: 50.00%CMS Modifier PricingSlte of Service: Yes -CMS AssignmeM (ASC POS 24 = F)Anesthesia Conversion Factor $ 54.00Anesthesia Rounding Option: ProrationSchedule Type: FFS

*All RVU and non-RVU based codes within these categories will be priced at the percent noted.

Uniese specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment. deductible or coinsurance that the customer Is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount tebe paid by the payer. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. Please remember that this information Is subject to theconfidentiality provisions of this agreement.





Ukiah Valley Primary Care Medical GroupAll other Products


Report Date01/24/2008 "


Last RouUne Maintenance Update: 01-01-2008Defautt Percent of Charges: 50.00%Anesthesia Conversion Factor: $ 54.00Anesthesia Rounding Option: Proration

Unless specifically indicated othenvise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-paymenL deducOble or coinsurance that the customer is responsible to pay under the customers benefit contract will be subtracted from the listed amount in determining the amount tobe paid by the payer. The actual payment amount is also subject to matters described In this agreement, such as the payment policies. Please remember that this information is subject to Ihe


Note: Maintenance to this fee schedule occurs routinely and may still occur after the repon date for the fee amounts selected.


Page 1



45380 00 COLONOSCOPY FLEX SURGERY DIGESTIVE NonFac $ 510.81

59400 00 ROUTINE OB CARE OBSTETRICS GLOBAL NonFac $ 2386.42

59510 00 ROUTINE OB CARE OBSTETRICS GLOBAL NonFac 5 2696.36

70553 00 MRI BRAIN; VV/O T RADIOLOGY - MRI NonFac S 769.13

70553 26 MRI BRAIN; W/O T RADIOLOGY - MRI NonFac S 84.42

70553 TC MR( BRAIN; YV/0 T RADIOLOGY - MRI NonFac $ 584.71

78465 00 MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE NonFac 5 399.63

78465 26 MYOCARD PERFUS I RADIOLOGY NUCLEAR MEDICINE NonFac S 54.86

78465 TC MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE NonFac S 344.77


88305 26 LEVEL IV - SURG LAB - PATHOLOGY NonFac $22.74

88305 TC LEVEL IV SURG LAB - PATHOLOGY NonFac S 38.88

90471 00 IMMUNIZATION ADM MEDICINE - OTHER NonFac $ 20.76

90669 00 PNEUMOCOCCAL CON IMMUNIZATIONS NonFac $ 94.88

93000 00 ECG-ROUTINE 12 L MEDICINE - OTHER NonFac $ 26.45

93307 00 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac $ 220.88

93307 26 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac $ 52.77

93307 TC ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac $ 168.11

93325 00 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR NonFac $ 112.36

93325 26 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR NonFac $ 426

97110 00 THERAP V> AREAS MEDICINE OTHER NonFac $28.49

97140 00 MNL TX TECH 1010 MEDICINE OTHER NonFac 9 26.86

98940 00 CHIROPRACTIC MAN MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT NonFac $ 25.70

98941 00 CHIROPRACTIC MAN MEDICINE - CHIROPRACT IC MANIPULATIVE TREATMENT NonFac $ 35.35


99203 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT NonFac 9 100.10


99205 00 OFFICE OUTPT NEW EVALUATION á MANAGEMENT NonFac $ 190.74


99213 00 OFCJOUTPT E&M ES EVALUATION & MANAGEMENT NonFac 9 64.88

99214 00 OFC/OUTPT EWA ES EVALUATION & MANAGEMENT NonFac $ 98.05

99215 00 OFCJOUTPT E&M ES EVALUATION & MANAGEMENT NonFac $ 132.65

99223 00 INIT HOSP-DAY E& EVALUATION & MANAGEMENT NonFac $ 188.67

99232 00 SUBSCIT HSP-DAY E EVALUATION & MANAGEMENT NonFac $ 69.21

99233 00 SUBSOT HOSP-DAY EVALUATION & MANAGEMENT NonFac $ 98.86

99243 00 OFFICE ChISLT NEW EVALUATION & MANAGEMENT NonFac $ 133.06

99244 00 OFC CNSLT NEW/ES EVALUATION 6 MANAGEMENT NonFac $ 195.26

99245 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT NonFac $ 242.23

99283 00 EMERG DEPT VISIT EVALUATION á MANAGEMENT NonFac $ 65.92

99284 00 ER VISIT E&M HIG EVALUATION 6 MANAGEMENT NonFac $ 119.87

99285 00 ER VISIT UM HIG EVALUATION & MANAGEMENT NonFac $ 179.61


99392 00 PRO PREV MEO E&M EVALUATION á MANAGEMENT - PREVENTIVE NonFac $ 86.36

99393 00 PRO PREV MEO E&M EVALUATION & MANAGEMENT - PREVENTIVE NonFac $ 85.56


99395 00 PRO PREV MEO E&M EVALUATION & MANAGEMENT - PREVENTIVE NonFac $ 94.76


J1745 00 INJECTION INFIJX INJECTABLES.ONCOLOGY/THERAPEUTIC CHEMO DRUGS NonFac $ 58.52

J2505 00 INJECTION PEGFIL INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS NonFac $ 2322.89

Last Routine Maintenance Update: 01-01-2008Default Percent of Charges: 50.00%Anesthesia Conversion Factor: S 54.00Anesthesia Rounding Option: Proration

Unless specifically indicated otherwise, amounts listed in die fee schedule represent global lees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payrnent, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount tobe paid by the payer. Tire actual payment amount Is also subject to matters described In this agreement, such as the payment policies. Please remember that this information is subject to The


Note: Maintenance to this fee schedule occurs routinely and may sfill occur after the report date for the fee amounts selected.


UnitedHealth NetworksgA UnitedHearth Group Company

Ukiah Valley Primary Care Medical GroupAll other Products

Representative Fee Schedule Sample for : CA 6213Fee amounts as of:01101/2008

Report Date:01/2412008*


Page 1



45380 00 COLONOSCOPY FLEX SURGERY - DIGESTIVE Fac 5 271.61

59400 00 ROUTINE OB CARE OBSTETRICS GLOBAL Fac $ 2386.42

59510 00 ROUTINE OB CARE OBSTETRICS - GLOBAL Fac 5 2696.36

70553 00 MRI BRAIN; W/O T RADIOLOGY - MRI Fac $ 769.13

70553 26 MRI BFIAIN; W/O T RADIOLOGY - NRI Fac 5 84.42

70553 TC MRI BRAIN; W/O T RADIOLOGY - MRI Fac $ 884.71



78465 TC MYOCARD PERFUS I RADIOLOGY NUCLEAR MEDICINE Fac $ 344.77



88305 TC LEVEL IV - SURG LAB - PATHOLOGY Fac 538.88

90471 00 IMMUNIZATION ADM MEDICINE - OTHER Fac $ 20.76

90669 00 PNEUMOCOCCAL CON IMMUNIZATIONS Fac $94.8893000 00 ECG-ROUTINE 12 L MEDICINE OTHER Fac $26.45

93307 00 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR Fac $220.86


93307 TC ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR Fac $ 168.11

93325 00 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR Fac 5112.36

93325 26 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR Fac $ 4.26

97110 00 THEFtAP 1/, AREAS MEDICINE - OTHER Fac $ 28.49

97140 00 MNL TX TECH 11M0 MEDICINE - OTHER Fac $ 26.86

98940 00 CHIROPRACTIC MAN MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT Fac 521.30










99223 00 INIT HOSP-DAY E& EVALUATION & MANAGEMENT Fac $ 188.67

99232 00 SUBSCIT HSP-DAY E EVALUATION & MANAGEMENT Fac $69.21

99233 00 SUBSCIT HOSP-DAY EVALUATION & MANAGEMENT Fac $ 98.86

99243 00 OFFICE CNSLT NEW EVALUATION á MANAGEMENT Fac $ 101.34

99244 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT Fac $ 158 60



99284 00 ER VISIT E&M MG EVALUATION & MANAGEMENT Fac $ 119.87

99285 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT Fac $ 179.61







J1745 00 INJECTION INFLIX INJECTABLES-ONCOLOGY/THERAPEUTIC CREMO DRUGS Fac $ 58.52

J2505 00 INJECTION PEGFIL INJECTABLES-ONCOLOGY/THERAPEUTIC CREMO DRUGS Fac $ 2322.89

CA 7205

UnitedHealth NetworksA GratedHealth Group Company


Market Standard SpecificationsCalifornia Market(s)Specifications as of:01/01/2008

Report Date:0112412008*

Unless specifically Indicated otherwise, amounts listed In the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for exampte, professional and technical

modifiers). Any copayment, deductible or coinsurance that the customer is responsible to pay under the customer's benefit contract will besubtracted from the listed amount in determining the amount to

be paid by the payer. The actual payment amount is also subject to mallare described in this agreement, such as the payment policies. Please remember that this infomiation is subject to the


Confidential and Proprietary Not for Distribution to Third PartiesPage 1

Market Mkt CMS Site of ServIce Linked Schedule IDStd carrierID locallty



EVALUATION & MANAGEMENT Current Year CMS RBRVS (3114099) 100.000%

EVALUATION & MANAGEMENT NEONATAL Current Year CMS RBRVS (3114099) 100.000%

EVALUATION & MANAGEMENT PREVENTIVE Current Year CMS RBRVS (3114099) 100.000%

SURGERY INTEGUMENTARY Current Year CMS RBRVS (3114099) 95.000%

SURGERY - MUSCULOSKELETAL Current Year CMS RBRVS (3114099) 95.000%

SURGERY RESPIRATORY Current Year CMS RBRVS (3114099) 95.000%

SURGERY - CARDIOVASCULAR Current Year CMS RBRVS (3114099) 95.000%

SURGERY - HEMIC & LYMPHATIC Current Year CMS RBRVS (3514099) 95.000%

SURGERY - MEDIASTINUM & DIAPHRAGM Current Year CMS RBRVS (3114099) 95.000%

SURGERY - DIGESTIVE Current Year CMS RBRVS (3114099) 95.000%

SURGERY - URINARY Current Year CMS RBRVS (3114099) 95.000%

SURGERY - MALE GENITAL Current Year CMS RBRVS (3114099) 95.000%

SURGERY - FEMALE GENITAL Current Year CMS RBRVS (3114099) 95.000%

SURGERY - MATERNITY & DELIVERY Current Year CMS RBRVS (3114099) 95.000%

SURGERY - ENDOCRINE Current Year CMS RBRVS (3114099) 95.000%

SURGERY - NERVOUS Current Year CMS RBRVS (3114099) 95.000%

SURGERY - EYE & OCULAR ADNEXA Current Year CMS RBRVS (3114099) 95.000%

SURGERY AUDITORY Current Year CMS RBRVS (3114099) 95.000%

FIADIOLOGY Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - BONE DENSITY Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - CT Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - MAMMOGRAPHY Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY MRI Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - MRA Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - NUCLEAR MEDICINE Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - PET SCANS Current Year CMS RBRVS (3114099) 70.000%

RADIATION THERAPY Current Year CMS RBRVS (3114099) 70.000%

RADIOLOGY - ULTRASOUND Current Year CMS RBRVS (3114099) 70.000%

LAB - PATHOLOGY Current Year CMS RBRVS (3114099) 60.000%

OFFICE LAB Current Year OMS Clinical Lab Schedule State Specific CA 60.000%

CUNICAL LABORATORY Current Year CMS Clinical Lab Schedule - State Specific CA 42.000%

MEDICINE - OPHTHALMOLOGY Current Year CMS RBRVS (3114099) 95.000%

MEDICINE. CARDIOVASCULAR Current Year CMS RBRVS (3114099) 95.000%

MEDICINE - ALLERGY & CLINICAL IMMUNOLOGY Current Year CMS RBRVS (3114099) 95.000%

MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT Current Year OMS RBRVS (3114099) 95.000%

MEDICINE - MODALITIES, THERAPIES Current Year CMS RBRVS (3114099) 95.000%

MEDICINE. OTHER Current Year CMS RBRVS (3114099) 95.000%

MEDICINE- CHEMO ADMIN Current Year CMS RBRVS (3114099) 95.000%

OBSTETRICS - GLOBAL Current Year CMS RBRVS (3114099) 95.000%

IMMUNIZATIONS CMS Drug Pricing 100.000%

INJECTABLES/OTHER DRUGS CMS Drug Pricing 100.000%

INJECTABLES - ONCOLOGY/THERAPEUTIC CHEMO DRUGS CMS Drug Pricing 100.000%

INJECTABLES -IVIG CMS Drug Pricing 100.000%

INJECTABLES-SALINE & DEXTROSE SOLUTIONS CMS Drug PricIng 100.000%

DME & SUPPLIES Current Year OMS DME State CA 65.000%

DME & SUPPLIES RESPIRATORY Current Year CMS DME State CA 65.000%

DME & SUPPLIES ORTHOTICS Current Year OMS DME State CA 65.000%

DME & SUPPLIES - PROSTHETICS Current Year CMS DME State CA 65.000%

AMBULANCE Current Year CMS Ambulance Schedule - Urban (3114099) 100.000%

Hard CodesDefault Percent of Charges: 35.00%OMS Modifier PricingSite of Service: Yes - CMS Assignment (ASC POS 24 = F)Anesthesia Conversion Factor 6 15.96Anesthesia Rounding Option: ProrationSchedule Type: FFS

UnitedHealth NetworksgA UnitedHealt Group Company


The purpose of this document is to provide additional information about this fee schedule, including clarity about the fee sources used to derive fees

and the type of routine maintenance changes that you can expect.

Primary Fee SourceThe primary fee source is the main fee source used as the basis for deriving the fee within each category of codes. For instance, if the fee schedule fora given category of codes is derived by applying a particular conversion factor to the relative value units (RVUs) in the CMS fee schedule, thoseCMS relative value units are the primary fee source.

Alternate (Gap-Fill) Fee SourceAlternate (or "gap fill") fee sources are used to fill gaps in the primary fee sources. For example, if a new CPT code has been created within thecategory of codes discussed above, and CMS has not yet established an RVU value for that code, we use one of the sources that exist within theindustry to fill that gap, such as but not limited to Ingenix Essential RBRVS. For that CPT code, we adopt the R'VU value established by the gapfill-fee source, and determine the fee schedule amount for that CPT code by applying to the gap-fill RVU the same conversion factor that we apply tothe CMS RVU for those CPT codes that have CMS RVUs. At such time in the future as CMS publishes its own RVU value for that CPT code, wewould begin using the primary fee source, CMS, to derive the fee for that code and no longer use the altemate source.

Percent of Charge DefaultIn the event that a fee is not sourced by either the primary or alternate fee source, such as services submitted using unclassified or miscellaneouscodes, the codes are subject to correct coding review and may be priced at the default Percent of Charge indicated in the attached document(s).

Fee Source LinksCMS Relative Values and Fee Schedules: www.cms.hhs.gov

MICROMEDEX Red Book: www.micromedex.com

Ingenix Essential RBRVS: www.ingenixonline.com

American Society of Anesthesiologists: www.asahq.org

Site of ServiceThis fee schedule generally follows CMS guidelines for determining when services are priced at the Facility or Nonfacility fee schedule (with theexception of services performed at Ambulatory Surgery Centers, POS 24, which will be priced at the Facility fee schedule). CMS guidelines can be

located at the website indicated above.

Routine MaintenanceUnited routinely updates its fee schedule in an effort to stay abreast of current coding practices widely used in the health care industry; in response toprice changes for immunizations and injectable medications; and to remain in compliance with the intent of the contractual agreement. Routinemaintenance occurs when United mechanically incorporates revised information created by a third party that is the source for a portion of the feeschedule. United will not generally attempt to communicate routine maintenance of this nature and will generally implement updates within 90 days

from the date of final publication from one of our primary or alternate fee sources. Providers may expect the following types of fee updates to their

fee schedules:

Changes to Relative Value Units, Conversion Factors, or Flat Rate FeesThis fee schedule follows a "Current Year" construction methodology. It is generally intended to remain current with RVU, Conversion Factor,

and Flat Rate Fee (non-RVU based fees such as Durable Medical Equipment fees) changes as the basis for deriving fees. As such, changespublished by the primary and/or alternate fee sources will similarly be reflected in this fee schedule.

Price Changes for Immunizations and Injectable MedicationsUnited routinely updates its fee schedule in response to price changes for immunizations and injectable medications published by the primaryand/or alternate fee sources. United currently utilizes CMS Drug Pricing and Thomson Micromedex Red Book AWP as its primary fee sources.Fees are generally updated on a calendar quarter basis within 90 days from the date of final publication but with an effective date of the first day of

Unless specifically indicated othetwise, amounts listed In the fee schedule represent global fees and May be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deductible or coinsurance that the customer is responsible lo pay under the customer's benefit contract will be subtracted from the listed amount in determining the amount to

be paid by the payer. The actual payment amount is also subject lo matters described in this agreement, such as the payment policies. Please remember that this information is subject to the

confidentiality provisions of this agreement

Note: Maintenance to thls fee schedule occurs routinely and may still occur after the report date for the fee amounts selected.

Confidential and Proprietary Not tor Distribution to Third Parties



the quarter following publication.

c. CPT/HCPCSUnited routinely updates its fee schedule in response to additions, deletions, and changes to CPT codes by the American Medical Association;HCPCS codes by the Centers for Medicaid and Medicare Services; and in response to similar changes (additions and revisions) to other servicecoding and reporting conventions that are widely used in the health care industry. Ordinarily, United's fee schedule is updated using the originalconstruction methodology along with the then-current RVU of the published CPT code.

United is committed to providing transparency related to our fee schedules. If you have questions about this fee schedule, please contact NetworkManagement at the address and phone number on your network participation agreement or you may use our fee schedule look-up function on the webat www.unitedhealthcareonline.com or contact our Voice Enabled Telephonic Self Service line at (877) 842-3210.

Page 3


Ukiah Valley Primary Care Medical GroupMedicare Advantage

Representative Fee Schedule Sample for : CA 7205Fee amounts as of:01/01/2008



Last Routine Maintenance Update: 01-01-2008Default Percent of Charges: 35.00%Anesthesia Conversion Factor: 5 15.96Anesthesia Rounding Option: Proration

Unless specifically indicated othenvise, amounts Ilsted In the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any copayment, deductible or colnsurance that the customer Is responsible to pay under the customer's benefit contract will be subtracted from the fisted amount in determining the amount lobe paid by the payer. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. Please remember that this information is subject lo the




Page 1



45380 00 COLONOSCOPY FLEX SURGERY DIGESTIVE NonFac S 435.94

59400 00 ROUTINE 06 CARE OBSTETRICS - GLOBAL NonFac $ 1548.11

59510 00 ROUTINE OB CARE OBSTETRICS GLOBAL NonFac S 1752.35

70553 00 MRI BRAIN; W/O T RADIOLOGY - MRI NonFac 5 459.19

70553 26 MRI BRAIN; W/O T RADIOLOGY - MRI NonFac $ 80.06

70553 TC MRI ElFtAIN; W/O T RADIOLOGY MRI NonFac S 379.13

78465 00 MYOCARD PERFUS I FtADIOLOGY - NUCLEAR MEDICINE NonFac 5 380.43

78465 26 MYOCARD PERFUS I RADIOLOGY NUCLEAR MEDICINE NonFac IS 52.65

78465 TC MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE NonFac $ 327.78

88305 00 LEVEL IV- SURG LAB - PATHOLOGY NonFac $ 63.74


88305 TC LEVEL IV - SURG LAB - PATHOLOGY NonFac $ 41.84

90471 00 IMMUNIZATION ADM MEDICINE OTHER NonFac $ 20.22

90669 00 PNEUMOCOCCAL CON IMMUNIZATIONS NonFac $ 78.80

93000 00 ECG-ROUTINE 12 L MEDICINE - OTHER NonFac $22.20

93307 00 ECHO TRNSTHOFtAC MEDICINE - CARDIOVASCULAR NonFac 5 187.17

93307 26 ECHO TRNSTHORAC MEDICINE CARDIOVASCULAR NonFac $45.4993307 TC ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR NonFac $ 141.68

93325 00 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR NonFac $ 76.01

93325 26 DOPPLR ECHO COLO MEDICINE CARDIOVASCULAR NonFac $ 3.56

97110 00 THERAP V» AREAS MEDICINE OTHER NonFac $26.12

97140 00 MM. TX TECH 1/M0 MEDICINE OTHER NonFac 5 24.40

98940 00 CHIROPRACTIC MAN MEDICINE - CHIROPRACTIC MANIPULATIVE TREATMENT NonFac $ 23.21

98941 00 CHIROPRACTIC MAN MEDICINE CHIROPRACTIC MANIPULATIVE TREATMENT NonFac $ 32.08





99212 00 OFC/OUTPT E&M ES EVALUATION á MANAGEMENT NonFac $ 38.19


99214 00 OFC/OUTPT E&M ES EVALUATION & MANAGEMENT NonFac $91.78


99223 00 INIT HOSP-DAY 06 EVALUATION & MANAGEMENT NonFac $ 173.09

99232 00 SUBSCIT HSP-DAY E EVALUATION & MANAGEMENT NonFac $ 63.85

99233 00 SUBSOT HOSP-DAY EVALUATION & MANAGEMENT NonFac $ 91.47

99243 00 OFFICE CNSLT NEW EVALUATION & MANAGEMENT NonFac $ 123.92



99283 00 EMERG DEPT VISIT EVALUATION & MANAGEMENT NonFac $ 58.69

99284 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT NonFac $ 108.58

99285 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT Nor/Fee $ 161.79

99391 00 PRO PREY MED E&M EVALUATION & MANAGEMENT - PREVENTIVE NonFaC $ 73.29


99393 00 PRD PREV MED E&M EVALUATION & MANAGEMENT. PREVENTIVE NonFac $ 80.89

99394 00 PRD PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE NonFac $ 88.66

99395 00 PRO PFtEV MED E&M EVALUATION & MANAGEMENT- PREVENTIVE NonFac $ 89.46


J1745 00 INJECTION INFL1X INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS NonFac $ 55.21

J2505 00 INJECTION PEGFIL INJECTABLES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS NonFac $ 2191.41

Last Routine Maintenance Update: 01-01-2008Default Percent of Charges: 35.00%Anesthesia Conversion Factor. $ 15.96Anesthesia Rounding Option: Proradon

Unless specifically indicated otherwise, amounts listed in the fee schedule represent global fees and may be subject to reductions based on appropriate modifier (for example, professional and technicalmodifiers). Any co-payment, deducible or coinsurance that the customer is responsible to pay under the customer's benefit contract will be subtracted from the listed amount In determining the amount tobe paid by the payar. The actual payment amount is also subject to matters described in this agreement, such as the payment policies. Please remember that this information is subject to the


* Note: Maintenance to this fee schedule occurs routinely and may still occur after the report date for the fee amounts selected.


UnitedHealth NetworksEA Unitedriealth Group Company

Ukiah Valley Primary Care Medical GroupMedicare Advantage

Representative Fee Schedule Sample for : CA 7206Fee amounts as of:01/01/2008

Report Date:01/2412008 *


Page 1

CPT Mod CPT Description Type of Service Place of Service Fue

45378 00 COLONOSCOPY FLEX SURGERY DIGESTIVE Fac $ 188.35


59400 00 ROUTINE OB CARE OBSTETRICS - GLOBAL Fac S 1548.11

59510 00 ROUTINE OB CARE OBSTETRICS - GLOBAL Fac $ 1752.35

70553 00 MRI BRAIN; W/O T RADIOLOGY - MRI Fac 5 459.19

70553 26 MRI BRAIN; W/O T RADIOLOGY MRI Fac $ 80.06

70553 TC MRI BRAIN; W/O T RADIOLOGY MRI Fac $ 379.13

78465 00 MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE Fac S 380.43

78465 28 MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE Fac S 52.65

78465 TC MYOCARD PERFUS I RADIOLOGY - NUCLEAR MEDICINE Fac S 327.78

88305 00 LEVEL IV - SURG I,AB PATHOLOGY Fac $ 63.74

88305 26 LEVEL IV - SURG LAI3 - PATHOLOGY Fac $ 21.90

88305 TC LEVEL IV - SURG LAB - PATHOLOGY Fac $$ 24

90471 00 IMMUNIZATION ADM MEDICINE - OTHER Fac $20.2290669 00 PNEUMOCOCCAL CON IMMUNIZATIONS Fac $ 78.80

93000 OD ECG-ROUTINE 12 L MEDICINE OTHER Fac $ 22.20

93307 00 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR Fac

$ $$1457.741993307 26 ECHO TRNSTHORAC MEDICINE - CARDIOVASCULAR Fac

93307 TC ECHO TRNSTHORAC MEDICINE CARDIOVASCULAR Fac S 141.68

93325 00 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR Fac $ 76.01

93325 26 DOPPLR ECHO COLO MEDICINE - CARDIOVASCULAR Fac S 3.56

97110 00 THERAP V> AREAS MEDICINE - OTHER Fac $ 26.12

97140 00 MNL TX TECH 1/M0 MEDICINE - OTHER Fac $ 24.40

98940 00 CHIROPRACTIC MAN MEDICINE- CHIROPRACTIC MANIPULATIVE TREATMENT Fac $ 19.39


99202 00 OFFICE OUTPT NEW EVALUATION á MANAGEMENT Fac $ 42.81

99203 00 OFFICE OUTPT NEW EVALUATION & MANAGEMENT Fac 5 65.53






99215 00 OFC/OUTPT E&M ES EVALUATION & MANAGEMENT Fac$$1$734.709799223 00 INIT HOSP-DAY E& EVALUATION & MANAGEMENT Fac

99232 00 SUBSOT HSP-DAY E EVALUATION & MANAGEMENT Fac $ 63.85

99233 00 SUBSOT HOSP-DAY EVALUATION & MANAGEMENT Fac

99243 00 OFFICE CNSLT NEW EVALUATION & MANAGEMENT Fac$$$1$94621.9$41099244 00 OFC CNSLT NEW/ES EVALUATION & MANAGEMENT Fac



99284 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT Fee $ 108.58

99285 00 ER VISIT E&M HIG EVALUATION & MANAGEMENT Fee $ 161.79


99392 00 PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac$5 9$5%699393 00 PRO PREV MED E&M MAEVALUATION & MANAGEMENT PREVENTIVE Fac 55

99394 00 PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac

99395 oo PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac $ 64.12

99396 00 PRO PREV MED E&M EVALUATION & MANAGEMENT - PREVENTIVE Fac

J1745 00 INJECTION INFLIX INJECTABLESONCOLOGY/THERAPEUTIC CHEMO DRUGS Fac $ 55.21

J2505 00 INJECTION PEGFIL INJECTAF3LES-ONCOLOGY/THERAPEUTIC CHEMO DRUGS Fac $ 2191.41

1110

For reference purposes, the following fee schedules will be used to pay claims under this agreement:

PRODUCTS: FEE SCHEDULES:

Commercial Options PPO ,CA 6250 and CA 6251

Commercial - All Othei CA 6212 and CA 6213

Medicare CA 7205 and CA 7206

PROVIDER DESCRIPTION


California Regulatory Requirements Appendix

In addition to our understandings in the agreement between you and us, there are certain additional items which Californialaws and regulations require us to include in our contract. This appendix sets forth those items and is made part of theagreement between you and us. These requirements apply to health care service plan products regulated under the Knox-Keene Health Care Service Plan Act of 1975 (Chapter 2.2 of Division 2 of the California Health & Safety Code) and itsimplementing regulations (Subchapter 5.5 of Chapter 3 of Title 10 of the California Code of Regulations) (the "Knox-Keene Act") or insurance products regulated under the California Insurance Code which are insured, sponsored, issued oradministered by or accessed through us to the extent such products are subject to regulation under California laws andregulations; provided, however, that the requirements in this appendix will not apply to the extent they are preempted bythe Medicare Modernization Act or other applicable law.

We each agree to be bound by the terms and conditions contained in this appendix. In the event of a conflict orinconsistency between this appendix and any term or condition contained in the agreement between you and us, thisappendix will control except with regard to benefit contracts outside the scope of this appendix.

This appendix will be deemed to be updated to incorporate any changes to the laws and regulations referenced herein,including any changes to definitions referenced herein, effective as of the date of such changes.

For the purpose of this appendix, "enrollee" means our customers who are enrolled in benefit contracts insured,sponsored, issued or administered by or accessed through us or any participating entity.

The California Depaitinent of Managed Health Care ("DMHC") regulates products governed by the Knox-Keene Act.The DMHC's address is 980 Ninth Street, Suite 500, Sacramento, CA 95814-2725, and the DMHC's website iswww.clmhc.ca.gov.

Provisions applicable to products regulated by the DMHC and governed by the Knox-Keene Act:

Enrollee Confidentiality. You will not disclose medical information regarding an enrollee unless suchdisclosure complies with the requirements of California Civil Code §56.10 and §56.104, as amended.

Network Participation. Upon our receipt of your signed copy of this agreement and upon any renewal of thisagreement, we will provide you with the disclosures described in California Health & Safety Code §1395.6, as amendedand as applicable, and will otherwise comply with the requirements of this law with respect to the sale, leasing or transferof this agreement to a payor other than us.

Amendment and Termination Due to Amendment. Any amendment proposed by us to change a material termof the agreement between you and us must be negotiated and agreed to by you. However, if the change is not material oris made to comply with state or federal law or regulations or any accreditation requirements of a private sectoraccreditation organization, we may amend this agreement without your consent. If we make a change to a material termof our agreement we will provide at least 45 business days' notice to you, unless a change in state or federal law orregulations or any accreditation requirements of a private sector accreditation organization require a shorter timeframe forcompliance. If we amend a manual, policy, or procedure document referenced in the agreement, we will provide at least45 business days' notice to you and you have the right to negotiate and agree to the change. If you and we cannot agree tothe change to a manual, policy, or procedure document, you have the right to terminate the agreement prior to theimplementation of the change. The 45 business days' notice requirements set forth in this section may be waived if youand we mutually agree, on a case by case basis. Except for changes that are not material or are made to comply with stateor federal law or regulations or accreditation requirements, you have the right to negotiate and agree to any proposedchange on a case-by-case basis at any time after you have received notice of the proposed change. For purposes of thissection only, the term "material," means a change to which a reasonable person would attach importance in determiningthe action to be taken upon the provision. This provision specifically supersedes any conflicting requirements in (1) thethird, fourth, fifth and sixth paragraphs in the section of this agreement entitled "What we will do"; (2) the secondparagraph in the section of this agreement entitled "How long our agreement lasts, how it gets amended and how it can

UnitedHealthcare Confidential and ProprietaryUHC/SMGA. 02.06. CA - / - 02/06

end"; (3) the "Administrative Guide" section in Appendix 1 of this agreement; and (4) section 3 in Appendix 3 of thisagreement.

Continuation of Care after Termination for Certain Conditions. If the agreement between you and us isterminated by us for any reason other than those relating to a medical disciplinary cause or reason, or fraud or othercriminal activity, you will, at the request of the enrollee and us, continue to provide covered health care services toenrollees with certain medical conditions as described in and pursuant to the California Health & Safety Code §1373.96,as amended, until the services are completed or the time limitations described therein have been reached. The provisionof the continued services for enrollees with these medical conditions is subject to the same contractual terms andconditions that were imposed upon you prior to termination, including the rate of compensation. Upon termination of thisagreement, we are liable for the covered health care services you provide (other than co-payments, coinsurance ordeductibles, as set forth in a subscriber's or enrollee's benefit contract) to a subscriber or enrollee who retains eligibilityunder the applicable benefit contract or by operation of law and who is under your care at the time of termination of theagreement until the covered services you provide to the subscriber or enrollee are completed or until we make reasonableand medically appropriate provisions for the assumption of such services by another contracted provider.

No Action at Law Against a Subscriber or Enrollee; Use of Surcharges. Neither you nor your agent, trusteeor assignee may maintain any action at law against a subscriber or enrollee to collect sums owed by us or a participatingentity to you for services provided to the subscriber or enrollee pursuant to this agreement. Upon notice of any suchaction or upon notice that you have imposed surcharges for covered services, we will take appropriate action. As used inthis appendix, the term "surcharges" means an additional fee which is charged to a subscriber or enrollee for a coveredservice but which is not approved by the Director of the DMHC, provided for in the plan contract and disclosed in theevidence of coverage or the disclosure form used as the evidence of coverage. This provision specifically supersedes anyconflicting requirements in the eight paragraph in the section of this agreement entitled "What you will do".

Maintenance and Access to Records. You will prepare and maintain such records and provide such informationto us or to the Director of the DMHC as may be necessary for our compliance with the provisions of the Knox-Keene Actand the rules thereunder. Such records must be maintained for at least two years, except that if our agreement requires alonger retention period, that longer period will apply. This obligation is not terminated upon a termination of theagreement, whether by rescission or otherwise. In addition, you will permit us to access at reasonable times upon demandyour books, records and documents relating to the health care services provided to subscribers and enrollees, to the costthereof and to payments you received from subscribers and enrollees (or from others on their behalf) for such services.

Access to Services. Your hours of operation and provision for after-hour services will be reasonable. We willhave a documented system for monitoring and evaluating accessibility of care, including a system for addressing problemsthat develop, which will include, but is not limited to, waiting times and appointments. In addition, you will provide orarrange for the provision of emergency health care services 24 hours a day, 7 days a week.

Authorization of Our Right to Offset any Uncontested Notice of Overpayment. In the event of anoverpayment and prior to any adjustment we make in future claims payments to you, we will provide you with a separatewritten notice of the overpayment of a claim or claims which clearly identifies the overpaid claim or claims, enrollee'sname and dates of service and explains the basis of our request for reimbursement of the overpayment. We will furnishsuch notice of overpayment to you within 365 calendar days after the date of the overpayment, unless the overpaymentwas caused in whole or in part by fraud or misrepresentation by you. If you intend to contest ournotice, you must sendwritten notice of your intent to contest within 30 business days of your receipt of our notice. If we do not receive a noticeof intent to contest our notice of the overpayment of a claim or claims or the requested reimbursement from you within theabove timeframes, you authorize us to offset the requested reimbursement amount from our cun-ent claims payments toyou. Additional information regarding this process is included in the PacifiCare Manual. This provision specificallysupersedes any conflicting requirements in the seventh paragraph in the section of this agreement entitled "What we willdo".

Submission of a Provider Dispute. You may obtain specific information regarding our provider disputeresolution mechanism in the PacifiCare Manual. You may submit information to us regarding provider disputes bywriting us or calling us at the location and telephone number listed on the cover page of the agreement We will inform

UnitedHeafthcare - Confidential and Proprietaty

UHC/SMGA. 02.06.CA -2- 02/06

you of any changes to our provider dispute procedures including any changes to the procedures for processing andresolving disputes and the location and telephone number where information regarding disputes may be submitted. Youwill receive the rights listed in California Health & Safety Code §1375.7, as amended, if we make any changes to ourprovider dispute resolution mechanism. This provision specifically supersedes any conflicting requirements in the firstparagraph in the section of this agreement entitled "What if we do not agree".

Appeals and Grievances of Enrollees. We will be responsible for resolving enrollee appeals and grievancespursuant to California Health & Safety Code §1368, as amended, and Title 28 of the California Code of Regulations§1300.68 as amended. You will assist us in the handling of complaints, grievances and appeals of enrollees consistentwith our enrollee appeals and grievances policies and procedures.

Quality Assurance Program. We will be responsible for maintaining a quality assurance program in compliancewith Title 28 of the California Code of Regulations §1300.70, as amended. You will assist us in maintaining our qualityassurance program, as applicable consistent with our quality assurance program policies and procedures.

No Balance Billing. Except for applicable co-payments, coinsurance and deductibles, you will not invoice orbalance bill any enrollees for the difference between your billed charges and the reimbursement paid for any coveredservice. In addition, in the event we or another participating entity fail to pay for health care services as set forth in thebenefit contract, the subscriber or enrollee will not be liable to you for any sums owed by us or such other participatingentity. This provision specifically supersedes any conflicting requirements in the eighth paragraph in the sectionof thisagreement entitled "What you will do".

Applicable Laws. We are subject to the requirements of Chapter 2.2 of Division 2 of the California Health andSafety Code, as amended, and Chapter 1 of Title 28 of the California Code of Regulations, as amended, and any provisionrequired to be in this agreement by either of the above will bind us whether or not provided for in the agreement. Youmay obtain additional information about California law and the Knox-Keene Act by referencing the PacifiCare Manual.

Reporting or Surcharges and Co-Payments. You will report to us all surcharge and co-payment moneys paidby subscribers and enrollees directly to you.

Payment of Claims. We or the applicable participating entity will pay claims in accordance with CaliforniaHealth & Safety Code §1371 et seq., as amended, and Title 28 of the California Code of Regulations §1300.71, asamended. Accordingly, without limitation: (a) in the event a claim is denied because it was filed beyond the claim filingdeadline, we will, upon your submission of a provider dispute and the demonstration of good cause for the delay, acceptand adjudicate the claim in accordance with Health & Safety Code §§1371 or 1371.35, as amended, whichever isapplicable, and applicable regulations; and (b) for each Complete Claim, as defined in Title 28 of the California Code ofRegulations §1300.71(a)(2), as amended, submitted by you which we or the participating entity does not deny or contest,we or the participating entity will pay the amount due to you within 45 working days following our receipt of theComplete Claim. In the event it is determined that a claim is not a Complete Claim, we will, within the timeframe setforth above for the payment of a Complete Claim, advise you of the basis upon which a claim is not eligible for paymentand specify any additional information required for us or the participating entity to pay the amount due with respect to theapplicable claim. Additional information regarding this process is included in the PacifiCare Manual. This provisionspecifically supersedes any conflicting requirements in (1) the fourth, sixth and seventh paragraphs in the section of thisagreement entitled "What you will do"; (2) the first and second paragraphs in the section of this agreement entitled "Whatwe will do"; and (3) section 2.1 in Appendix 3 of this agreement.

Block Transfer Filing Requirements. We will comply with the block transfer filing requirements set forth inCalifornia Health and Safety Code Section 1373.65, as it may be amended. For any benefit contracts in which a blocktransfer notice is required, the effective date of termination for such benefit contracts will be 90 days following the receiptof termination notice, unless a longer period is required by this agreement. The90-day termination notice period will notimpact the termination date for benefit contracts in which a block transfer notice is not required. This provisionspecifically supersedes any conflicting requirements in the third paragraph in the section of this agreement entitled "Howlong our agreement lasts; how it gets amended; and how it can end.

UnitedHealthcare Confidential and Proprietary

UHC/SMGA. 02.06.CA -3- 02/06

17. Termination For Cause. As directed by the DMHC, in the event we seek to terminate this agreement for causeon the basis of your material breach of the requirement to conduct business with us entirely on an electronic basis withinone year of the effective date of the agreement, we shall provide you with 180 days prior written notice and you shall have180 days from the receipt of such notice to cure the deficiency in order to avoid termination.

Provisions applicable to products regulated by the California Department of Insurance ("DO!") and governed bythe California insurance laws:

Enrollee Confidentiality. You will not disclose medical information regarding an enrollee unless suchdisclosure complies with the requirements of California Civil Code §56.10 and §56.104, as amended.

Network Participation. Upon our receipt of your signed copy of this agreement and upon any renewal of thisagreement, we will provide you with the disclosures described in California Business & Professions Code §511.1 orCalifornia Insurance Code §10178.3, as amended and as applicable, and will otherwise comply with the requirements ofthese laws, as applicable, with respect to the sale, leasing or transfer of this agreement to a payor other than us.

Amendment and Termination Due to Amendment. We may make a change to our quality improvement orutilization management program at any time without your consent if the change is necessary to comply with state orfederal law or regulations or any accreditation requirements of a private sector accreditation organization. In addition, wemayamend the agreement. If our proposed amendment involves a material change to the agreement or to our qualityimprovement or utilization management programs, we will provide at least 45 business days' notice to you and you mayterminate the agreement by providing written notice to us of your intent to terminate this agreement, as further describedin the agreement. Nothing in this section limits the ability of you and we to mutually agree to the proposed materialchange at any time after you have received notice of the proposed material change. For purposes of this section only, theterm "material" means a change to which a reasonable person would attach importance in determining the action to betaken upon the provision.

Continuation of Care after Termination for Certain Conditions. If the agreement between you and us isterminated by us for any reason other than those relating to a medical disciplinary cause or reason, or fraud or othercriminal activity, you will, at the request of the enrollee and us, continue to provide covered health care services toenrollees with certain medical conditions as described in and pursuant to the California Insurance Code §10133.56, asamended, until the services are completed or the time limitations described therein have been reached. The provision ofthe continued services for enrollees with these medical conditions is subject to the same contractual terms and conditionsthat were imposed upon you prior to termination, including the rate of compensation.

Dispute Procedure. We will inform you of any changes to our provider dispute procedures including anychanges to the procedures for processing and resolving disputes and the location and telephone number where informationregarding disputes may be submitted.

Exclusive Provider Services. When your services with regard to an enrollee covered under a particular benefitcontract are "exclusive provider services," as that term is used and defined in Title 10 of the California Code ofRegulations §2240, as amended, you will not make any additional charge to your patient except as provided for in thegroup contract. Our agreement includes the entire agreement between us regarding yourprovision of exclusive providerservices to our enrollees. With regard to our enrollees to whom you provide exclusive provider services, your primaryconcern will be the quality of health care services rendered to those patients.

Payment of Claims. We or the applicable participating entity will pay claims in accordance with Chapter 1 ofPart 2 of Division 2 of the California Insurance Code, as amended. Accordingly, without limitation: (a) in the event aclaim is denied because it was filed beyond the claim filing deadline, we will, upon demonstration by you of good causefor the delay, accept and adjudicate the claim in accordance with Insurance Code §§10123.13 or 10123.147, as amended,whichever is applicable; and (b) for any claim or portion of any claim submitted by you that is not contested or denied by

UnitedHealthcare Confidential and ProprietaryUHC/SMGA. 02.06.CA -4- 02/06

us or the participating entity, we or the participating entity will pay the amount due to you within 30 working daysfollowing our receipt of the claim. In the event that a claim is contested or denied by us or the participating entity, wewill, within the timeframe set forth above, furnish you the information required by Insurance Code §§10123.13 or10123.147, as amended, as applicable. If a claim or portion thereof is contested on the basis that we have not receivedinformation reasonably necessary to determine our or the participating entity's liability for the claim or portion thereof,then we will have 30 working days after receipt of this additional information to complete reconsideration of the claim;and (c) "Complete Claim" as used in the Agreement will have the meaning set forth in Insurance Code §10123.147(c), asamended.

8. Reimbursement Requests for the Overpayment of a Claim. We will not request reimbursement for theoverpayment of a claim unless we send you a written request for reimbursement within 365 days of the date of payment ofthe overpaid claim. The written notice will clearly identify the claim, the name of the patient, and the date of service, andwill include a clear explanation of the basis upon which it is believed the amount paid on the claim was in excess of theamount due, including interest and penalties on the claim. The 365 day time limit will not apply if the overpayment wascaused in whole or in part by your fraud or misrepresentation.

UnitedHealthcare Confidential and ProprietaryUHC/SMGA. 0206. CA -5- 02/06

Medical Group ContractMedicare Advantage Regulatory Appendix

The provisions contained in this appendix supplement the Medical Group Contract between you and us.You have agreed to provide services to Medicare customers. Because Medicare customers receive theircoverage under Medicare Advantage contracts between the Centers for Medicare and Medicaid Services

("CMS") and us or other participating entities (collectively "Medicare Advantage Plans"), applicableMedicare Advantage regulations and CMS guidelines require that the provisions contained in thisappendix be part of the Medical Group Contract. For Medicare Advantage Plans, the provisions in thisappendix supersede any inconsistent provisions that may be found elsewhere in the Medical GroupContract.

Data. You will cooperate with us in our efforts to report to CMS all statistics and otherinformation related to our business, as may be requested by CMS. You will send us all encounterdata and other Medicare program-related information as may be requested by us, within thetimeframes we specify and in a form that meets Medicare program requirements. By submittingencounter data to us, you represent to us, and upon our request you will certify in writing, that thedata is accurate and complete, based on your best knowledge, information and belief. If any ofthis data turns out to be inaccurate or incomplete, according to Medicare Advantage rules, we maywithhold or deny payment to you.

Policies. You will cooperate and comply with all our policies and procedures, credentialing plan andprovider administrative manual.

Payment. We will promptly process and pay your claim no later than 60 days after we receive allappropriate information as described in our administrative procedures. If you are responsible formaking payment to subcontracted providers, you will pay them within this same timeframe.

Customer Protection. You agree that in no event, including but not limited to, non-payment by usor an intermediary, insolvency of us or an intermediary, or breach by us of the Medical GroupContract, will you bill, charge, collect a deposit from, seek compensation, remuneration orreimbursement from, or have any recourse against any customer or person (other than us or anintermediary) acting on behalf of the customer for covered services provided pursuant to the MedicalGroup Contract. This provision does not prohibit you from collecting copayments, coinsurance orfees for services not covered under the customer's benefit contract and delivered on a fee-for-servicebasis to the customer. This provision does not prohibit you and a customer from agreeing to continueservices solely at the expense of the customer, as long as you have clearly informed the customer thatthe benefit contract may not cover or continue to cover a specific service or services.

In the event of our or an intermediary's insolvency or other cessation of operations or termination ofour contract with CMS, you will continue to provide covered services to customers through the laterof the period for which premium has been paid to us on behalf of the customer, or, in the case ofcustomers who are hospitalized as of such period or date, until the customer's discharge. Coveredservices for a customer confined in an inpatient facility on the date of insolvency or other cessation ofoperations will continue until the customer's continued confinement in an inpatient facility is nolonger medically necessary.

This provision will be construed in favor of the customer, will survive the termination of the MedicalGroup Contract regardless of the reason for termination, including our insolvency, and will supersedeany oral or written contrary agreement between you and a customer or the representative of acustomer if the contrary agreement is inconsistent with this provision.

DB052505 1

For the purpose of this provision, an "intermediary" is a person or entity authorized to negotiateand execute the Medical Group Contract on behalf of you or on behalf of a network throughwhich you elect to participate.

Eligibility. You agree to immediately notify United in the event you are or become disbarred,excluded, suspended or otherwise determined to be ineligible to participate in federal health careprograms. You shall not employ or contract with, with or without compensation, any individual orentity that has been disbarred, excluded, suspended or otherwise determined to be ineligible toparticipate in federal health care programs.

Laws. Each of us will comply with all applicable Medicare laws, regulations and CMS instructionsand will cooperate with the other's efforts to comply. You will also cooperate with us in ourefforts to comply with our contract with CMS.

Records. The Secretary of Health and Human Services, the Comptroller General and we will havethe right to audit, evaluate and inspect any books, contracts, medical records, patient caredocumentation and other records belonging to you that pertain to the Medical Group Contractand other program-related matters deemed necessary by the person conducting the audit,evaluation or inspection. This right shall extend through 10 years from the later of the last day of aCMS contract period or completion of any audit, or longer in certain instances described in theapplicable Medicare Advantage regulations. You will make your premises, facilities and equipmentavailable for these activities. You will maintain medical records in an accurate and timely manner.You will ensure that customers have timely access to medical records and information that pertainto them. Each of us will safeguard the privacy of any health information that identifies a customerand abide by all federal and state laws regarding privacy, confidentiality and disclosure of rnedicalrecords and other health and customer information.

Accountability. You agree that we oversee and are accountable to CMS for any responsibilitiesthat are contained in our contract with CMS, including those that we may delegate to you orothers. Any responsibilities that are delegated must be specified in a written arrangement with theother party. The arrangement must include any reporting requirements, a right of revocation,performance monitoring by us, ongoing review, approval and auditing of credentialing processes,if applicable, and compliance with all applicable Medicare laws, regulations and CMS instructions.

Subcontracts. If you have subcontract arrangements with other providers to deliver coveredservices to our customers, you will ensure that your contracts with those subcontracted providerscontain all of the provisions in this appendix and will provide proof of such to us upon request.

DB052505 2

this amendment, effective on april 1, 2009 (effective date...

Documents