Provider Types Provider Type Code Provider Type Fee

1 Physicians and Surgeons See By ISO Code Listing

2 Resident Physicians and Surgeons See By ISO Code Listing

3 Moonlighters Flat fee of $229 per year

4 MCOW Full-time Faculty See By ISO Code Listing

7 Retired or Part-Time Physician or Surgeon Flat fee of $95 per year

30 Nurse Anesthetist Flat fee of $94 per year

50 Out-of-state Physician and Surgeon See By ISO Code Listing

51 Out-of-state Nurse Anesthetist Flat fee of $48 per year

60 Half-Time Physician or Surgeon See By ISO Code Listing ISO Premium Code Classification Class Provider Type 4 1 2 Medical 50 In State Medical College Out of 60 Full-time Resident Faculty State Half Time 80101 Broncho-Esophagology 2 688 344 274 344 412 80102 Emergency Medicine-No Major Surgery 2 688 344 274 344 412 80103 Surgery-Endocrinology 2 688 344 274 344 412 80104 Surgery-Gastroenterology 2 688 344 274 344 412 80105 Surgery-Geriatrics 2 688 344 274 344 412 80106 Surgery-Laryngology 3 1,528 764 608 764 916 80107 Surgery-Neoplastic 2 688 344 274 344 412 80108 Surgery-Nephrology 2 688 344 274 344 412 80114 Surgery-Opthalmology 2 688 344 274 344 412 80115 Surgery-Colon & Rectal 2 688 344 274 344 412 80117 Surgery-General Practice 2 688 344 274 344 412 80120 Administrative Medicine 1 382 191 152 191 229 80121 Urology-No Surgery 1 382 191 152 191 229 80141 Surgery-Cardiac 3 1,528 764 608 764 916 80143 Surgery-General 3 1,528 764 608 764 916 80144 Surgery-Thoracic 3 1,528 764 608 764 916 80145 Surgery-Urological 2 688 344 274 344 412 80146 Surgery-Vascular 3 1,528 764 608 764 916 80150 Surgery-Cardiovascular Disease 3 1,528 764 608 764 916 80151 Anesthesiology 2 688 344 274 344 412 80152 Surgery-Neurology-including child 4 2,521 1,261 1,003 1,261 1,511 80153 Surgery-OB/GYN 4 2,521 1,261 1,003 1,261 1,511 80154 Surgery-Orthopedic 3 1,528 764 608 764 916 80155 Surgery-Plastic-Otorhinolaryngology 3 1,528 764 608 764 916 80156 Surgery-Plastic 3 1,528 764 608 764 916 80157 Emergency Medicine-includes major surgery 3 1,528 764 608 764 916 80158 Otology-no plastic 3 1,528 764 608 764 916 80159 Surgery-Otorhinolaryngology 3 1,528 764 608 764 916 80160 Surgery-Rhinology 3 1,528 764 608 764 916 80161 Shock Therapy-emp. phy or surg 3 1,528 764 608 764 916 80162 Shock Therapy-insured 1 382 191 152 191 229 80163 Radiation Therapy Emp. phy or surg. maj surg 3 1,528 764 608 764 916 80165 Radiation Therapy-other than lasers 2 688 344 274 344 412 80166 Surgery-Abdominal 3 1,528 764 608 764 916 80167 Surgery-Gynecology 3 1,528 764 608 764 916 80168 Surgery-Obstetrics 4 2,521 1,261 1,003 1,261 1,511 80169 Surgery-Hand 3 1,528 764 608 764 916 80170 Surgery-Head & Neck 3 1,528 764 608 764 916 80171 Surgery-Traumatic 3 1,528 764 608 764 916 80177 Employed Physician or Surgeon 2 688 344 274 344 412 80179 Retired Physicians & Surgeons See Provider Types 80180 Weight Control-Bariatrics 3 1,528 764 608 764 916 80182 Pain Management - Basic Procedures 2 688 344 274 344 412 80208 Pain Management - No Surgery 1 382 191 152 191 229 80230 Aerospace Medicine 1 382 191 152 191 229 80231 General Preventive Medicine-no surgery 1 382 191 152 191 229 80232 Hypnosis 1 382 191 152 191 229 80233 Occupation Medicine 1 382 191 152 191 229 80234 Pharmocology-Clinical 1 382 191 152 191 229 80235 Physiatry-Physical Medicine & Rehabilitation 1 382 191 152 191 229 ISO Premium Code Classification Class Provider Type 4 1 2 Medical 50 In State Medical College Out of 60 Full-time Resident Faculty State Half Time 80236 Public Health 1 382 191 152 191 229 80237 Diabetes-no surgery 1 382 191 152 191 229 80238 Endocrinology-no surgery 1 382 191 152 191 229 80240 Forensic Medicine-Legal Medicine 1 382 191 152 191 229 80241 Gastroenterology-no surgery 1 382 191 152 191 229 80243 Geriatrics-no surgery 1 382 191 152 191 229 80244 Gynecology-no surgery 1 382 191 152 191 229 80245 Hematology-no surgery 1 382 191 152 191 229 80246 Infectious Diseases-no surgery 1 382 191 152 191 229 80247 Rhinology-no surgery 1 382 191 152 191 229 80248 Nutrition 1 382 191 152 191 229 80249 Psychiatry-including child 1 382 191 152 191 229 80250 Psychoanalysis 1 382 191 152 191 229 80251 Psychosomatic Medicine 1 382 191 152 191 229 80252 Rheumatology-no surgery 1 382 191 152 191 229 80253 Radiology-diagnostic 1 382 191 152 191 229 80254 Allergy 1 382 191 152 191 229 80255 Cardiovascular Disease-no surgery 1 382 191 152 191 229 80256 Dermatology-no surgery 1 382 191 152 191 229 80257 Internal Medicine-no surgery 1 382 191 152 191 229 80258 Laryngology-no surgery 1 382 191 152 191 229 80259 Neoplastic Disease-no surgery 1 382 191 152 191 229 80260 Nephrology-no surgery 1 382 191 152 191 229 80261 Neurology-including child-no surgery 1 382 191 152 191 229 80262 Nuclear Medicine 1 382 191 152 191 229 80263 Ophthalmology-no surgery 1 382 191 152 191 229 80264 Otology-no surgery 1 382 191 152 191 229 80265 Otorhinolaryngology-no surgery 1 382 191 152 191 229 80266 Pathology-no surgery 1 382 191 152 191 229 80267 Pediatrics-no surgery 1 382 191 152 191 229 80268 Physicians-no surgery 1 382 191 152 191 229 80269 Pulmonary Disease-no surgery 1 382 191 152 191 229 80270 Rhinology-minor surgery 2 688 344 274 344 412 80271 Diabetes-minor surgery 2 688 344 274 344 412 80272 Endocrinology-minor surgery 2 688 344 274 344 412 80274 Gastroenterology-minor surgery 2 688 344 274 344 412 80276 Geriatrics-minor surgery 2 688 344 274 344 412 80277 Gynecology-minor surgery 2 688 344 274 344 412 80278 Hematology-minor surgery 2 688 344 274 344 412 80279 Infectious Diseases-minor surgery 2 688 344 274 344 412 80280 Radiology-diagnostic - interventional procedures 2 688 344 274 344 412 80281 Cardiovascular Disease-minor surgery 2 688 344 274 344 412 80282 Dermatology-minor surgery 2 688 344 274 344 412 80283 Intensive Care Medicine 2 688 344 274 344 412 80284 Internal Medicine-minor surgery 2 688 344 274 344 412 80285 Laryngology-minor surgery 2 688 344 274 344 412 80286 Neoplastic Disease-minor surgery 2 688 344 274 344 412 80287 Nephrology-minor surgery 2 688 344 274 344 412 80288 Neurology-including child-minor surgery 2 688 344 274 344 412 80289 Opthalmology-minor surgery 2 688 344 274 344 412 80290 Otology-minor surgery 2 688 344 274 344 412 ISO Premium Code Classification Class Provider Type 4 1 2 Medical 50 In State Medical College Out of 60 Full-time Resident Faculty State Half Time 80291 Otorhinolaryngology 2 688 344 274 344 412 80292 Pathology-minor surgery 2 688 344 274 344 412 80293 Pediatrics-minor surgery 2 688 344 274 344 412 80294 Physicians-minor surgery 2 688 344 274 344 412 80296 Hospitalist 2 688 344 274 344 412 80298 Neonatologist 2 688 344 274 344 412 80301 Oncology - Minor Surgery 2 688 344 274 344 412 80302 Oncology - No Surgery 1 382 191 152 191 229 80420 Family or General Practice 1 382 191 152 191 229 80421 Family or General Practice including OB 2 688 344 274 344 412 surgery (No surgery, Minor OB) 80422 Angiography-Arteriography-Cat 2 688 344 274 344 412 80423 Family Practice - No OB 2 688 344 274 344 412 80424 Urgent Care - Walk-in or After Hours 1 382 191 152 191 229 80425 Radiation Therapy-lasers 2 688 344 274 344 412 80428 Myelography-Discograms-Pneumo 2 688 344 274 344 412 80431 Shock Therapy 1 382 191 152 191 229 80434 Phlebography-lymphangeography 2 688 344 274 344 412 80437 Acupuncture 2 688 344 274 344 412 80440 Laparoscopy 2 688 344 274 344 412 80443 Colonoscopy-ERCP-pneu. or mech. 2 688 344 274 344 412 80446 Needle Biopsy 2 688 344 274 344 412 80449 Radiopaque Dye 1 382 191 152 191 229 80452 Employed Nurse Anesthetists See Provider Types 80453 Outpatient Surgical Facilities 17-$5.94 per 100 OP visits 80476 Bariatrics 3 1,528 764 608 764 916 Provider Type 13-$22.50 per occupied bed, plus $1.15 per 80611 Hospital-for-profit 100 OP visits Provider Type 13-$22.50 per occupied bed, plus $1.15 per 80612 Hospital-not-for-profit 100 OP visits $100 or 7.0% based on occurrence primary coverage or 10% 80613 Clinics, Outpatient-Entities based on claims-made coverage 80613 Service Corp Non Stock Provider type 26 2 to 10 2 to 10 $14 11 to 100 11 to 100 $131 101 or more 101 or more $329

$100 or 7.0% based on occurrence primary coverage or 10% 80614 Clinics, dispensaries, or infirmaries, outpatient based on claims-made coverage 80616 Registered nurse applying anesthetics See Provider Types $100 or 7.0% based on occurrence primary coverage or 10% 80715 Medical or X-Ray Lab based on claims-made coverage 80913 Certified Nurse Anesthetist See Provider Types Provider Type 13-$22.50 per occupied bed, plus $1.15 per 80916 Mental-Psychopathic Institutions not for profit 100 OP visits 80923 Nursing Home-for profit Provider Type 14-$4.50 per occupied 80924 Nursing Home-not-for-profit Provider Type 14-$4.50 per occupied Provider Type 13-$22.50 per occupied bed, plus $1.15 per 80925 Sanitariums or Health Institutions for profit 100 OP visits Provider Type 13-$22.50 per occupied bed, plus $1.15 per 80926 Sanitariums or Health Institutions not for profit 100 OP visits 80960 Nurse Anesthetist See Provider Types ISO Premium Code Classification Class Provider Type 4 1 2 Medical 50 In State Medical College Out of 60 Full-time Resident Faculty State Half Time Provider Type 13-$22.50 per occupied bed, plus $1.15 per 80997 Mental-Psychopathic Institutions for profit 100 OP visits 80999 Corporate/Partnership Liability Provider type 26 2 to 10 $14 11 to 100 $131 101 or more $329 Provider type 15, 16, & 19 2 to 10 $14 11 to 100 $131 101 or more $329

Cooperatives Provider Type 18 $0.05 per 100 visits, plus 2.5% of Fund fees of all physicians plus allied health care professionals.

81102 Post Grad. Med. Education-Outside (Moonlighting) See Provider Types Med. Pract Only (Moonlighting) Provider Type 03-515 84102 Emergency Medicine-No Major Surgery (DO) 2 688 344 274 344 412 84104 Surgery-Gastroenterology (D.O.) 2 688 344 274 344 412 84114 Surgery-Ophthalmology (D.O.) 2 688 344 274 344 412 84117 Surgery-General Practice (D.O.) 2 688 344 274 344 412 84143 Surgery-General (D.O.) 3 1,528 764 608 764 916 84144 Surgery-Thoracic (D.O.) 3 1,528 764 608 764 916 84145 Surgery-Urological (D.O.) 2 688 344 274 344 412 84146 Surgery-Vascular 3 1,528 764 608 764 916 84150 Surgery-Cardiovascular Disease (D.O.) 3 1,528 764 608 764 916 84151 Anesthesiology (D.O.) 2 688 344 274 344 412 84152 Surgery-Neurology-including child (D.O.) 4 2,521 1,261 1,003 1,261 1,511 84153 Surgery-OB/GYN (D.O.) 4 2,521 1,261 1,003 1,261 1,511 84154 Surgery-Orthopedic (D.O.) 3 1,528 764 608 764 916 84155 Surgery-Plastic-Otorhinolaryngology (D.O.) 3 1,528 764 608 764 916 84156 Surgery-Plastic (D.O.) 3 1,528 764 608 764 916 84157 Emergency Medicine-includes major surgery (D.O.) 3 1,528 764 608 764 916 84161 Shock Therapy-emp. phy or surg (maj surg) (D.O.) 3 1,528 764 608 764 916 84163 Radia. Ther.-emp. phy or surg (maj surg) (D.O.) 3 1,528 764 608 764 916 84167 Surgery-Gynecology (D.O.) 3 1,528 764 608 764 916 84171 Surgery-Traumatic (D.O.) 3 1,528 764 608 764 916 84177 Employed Physician or Surgeon (D.O.) 2 688 344 274 344 412 84179 Retired Physicians & Surgeons (D.O.) See Provider Types 84182 Pain Management - Basic Procedures 2 688 344 274 344 412 84208 Pain Management - No Surgery 1 382 191 152 191 229 84231 General Preventive Medicine 1 382 191 152 191 229 84233 Occupation Medicine (D.O.) 1 382 191 152 191 229 84235 Physiatry - Physical Medicine (D.O.) 1 382 191 152 191 229 84238 Endocrinology-no surgery (D.O.) 1 382 191 152 191 229 84240 Forensic Medicine-Legal Medicine (D.O.) 1 382 191 152 191 229 84241 Gastroenterology-no surgery (D.O.) 1 382 191 152 191 229 84243 Geriatrics-no surgery (D.O.) 1 382 191 152 191 229 84244 Gynecology-no surgery (D.O.) 1 382 191 152 191 229 84245 Hematology-no surgery (D.O.) 1 382 191 152 191 229 84246 Infectious Diseases-no surgery 1 382 191 152 191 229 ISO Premium Code Classification Class Provider Type 4 1 2 Medical 50 In State Medical College Out of 60 Full-time Resident Faculty State Half Time 84249 Psychiatry-including child (D.O.) 1 382 191 152 191 229 84251 Psychosomatic Medicine (D.O.) 1 382 191 152 191 229 84252 Rheumatology-no surgery (D.O.) 1 382 191 152 191 229 84253 Radiology-diagnostic (D.O.) 1 382 191 152 191 229 84254 Allergy (D.O.) 1 382 191 152 191 229 84255 Cardiovascular Disease-no surgery (D.O.) 1 382 191 152 191 229 84256 Dermatology-no surgery (D.O.) 1 382 191 152 191 229 84257 Internal Medicine-no surgery (D.O.) 1 382 191 152 191 229 84260 Nephrology - no surgery (D.O.) 1 382 191 152 191 229 84261 Neurology-including child-no surgery (D.O.) 1 382 191 152 191 229 84262 Nuclear Medicine (D.O.) 1 382 191 152 191 229 84263 Ophthalmology-no surgery (D.O.) 1 382 191 152 191 229 84265 Otorhinolaryngology-no surgery (D.O.) 1 382 191 152 191 229 84266 Pathology-no surgery (D.O.) 1 382 191 152 191 229 84267 Pediatrics-no surgery (D.O.) 1 382 191 152 191 229 84268 Physicians-no surgery (D.O.) 1 382 191 152 191 229 84269 Pulmonary Disease-no surgery (D.O.) 1 382 191 152 191 229 84171 Diabetes-minor surgery (D.O.) 2 688 344 274 344 412 84272 Endocrinology-minor surgery (D.O.) 2 688 344 274 344 412 84274 Gastroenterology-minor surgery (D.O.) 2 688 344 274 344 412 84276 Geriatrics-minor surgery (D.O.) 2 688 344 274 344 412 84277 Gynecology-minor surgery (D.O.) 2 688 344 274 344 412 84278 Hematology-minor surgery (D.O.) 2 688 344 274 344 412 84280 Radiology-diagnostic-minor surgery (D.O.) 2 688 344 274 344 412 84281 Cardiovascular Disease-minor surgery (D.O.) 2 688 344 274 344 412 84282 Dermatology-minor surgery (D.O.) 2 688 344 274 344 412 84283 Intensive Care Medicine (D.O.) 2 688 344 274 344 412 84284 Internal Medicine-minor surgery (D.O.) 2 688 344 274 344 412 84288 Neurology-including child-minor surgery (D.O.) 2 688 344 274 344 412 84289 Opthalmology-minor surgery (D.O.) 2 688 344 274 344 412 84291 Otorhinolaryngology-minor surgery (D.O.) 2 688 344 274 344 412 84292 Pathology-minor surgery (D.O.) 2 688 344 274 344 412 84293 Pediatrics-minor surgery (D.O.) 2 688 344 274 344 412 84294 Physicians -minor surgery (D.O.) 2 688 344 274 344 412 84296 Hospitalist (D.O.) 2 688 344 274 344 412 84298 Neonatologist 2 688 344 274 344 412 84301 Oncology - Minor Surgery 2 688 344 274 344 412 84302 Oncology - No Surgery 1 382 191 152 191 229 84420 Family or General Practice (D.O.) 1 382 191 152 191 229 84421 Family or General Practice-including OB (D.O.) 2 688 344 274 344 412 84422 Angiography-arteriography-catheterization (D.O.) 2 688 344 274 344 412 84423 Family Practice - No OB 2 688 344 274 344 412 84424 Ugent Care - Walk-in or After Hours 1 382 191 152 191 229 84425 Radiation Therapy-lasers (D.O.) 2 688 344 274 344 412 84428 Myelography-discograms-pneumoencephalo (D.O.) 2 688 344 274 344 412 84431 Shock Therapy (D.O.) 1 382 191 152 191 229 84434 Phlebography-lymphangeography (D.O.) 2 688 344 274 344 412 84437 Acupuncture (D.O.) 2 688 344 274 344 412 84440 Laparoscopy (D.O.) 2 688 344 274 344 412 84443 Colonoscopy-ERCP-Pneu or mech esoph dil (D.O.) 2 688 344 274 344 412 84446 Needle Biopsy (D.O.) 2 688 344 274 344 412 ISO Premium Code Classification Class Provider Type 4 1 2 Medical 50 In State Medical College Out of 60 Full-time Resident Faculty State Half Time 84449 Radiopaque Dye (D.O.) 1 382 191 152 191 229 84452 Employed Nurse Anesthetists (D.O.) See Provider Types 84453 Outpatient Surgical Facilities (D.O.) Provider Type 17-$5.94 per 100 OP visits 84476 Bariatrics 3 1,528 764 608 764 916 84801 Manipulator/Osteopathy (D.O.) 1 382 191 152 191 229 $100 or 7.0% based on occurrence primary coverage or 10% 84803 Outpatient Clinic-DO based on claims-made coverage Provider Type 13-$22.50 per occupied bed, plus $1.15 per 84965 Hospital-Osteopathic 100 OP visits 84999 Corp or Part Liab - DO Provider type 15, 16, & 19 2 to 10 $14 11 to 100 $131 101 or more $329 Facility charges for other Employed Health Care Persons

Nurse Practitioner $ 95.00

Advanced Nurse Practitioner $ 133.00

Nurse Midwives $ 839.00

Advanced Nurse Midwives $ 878.00

Advanced Practice Nurse Prescribers $ 133.00

Chiropractors $ 152.00

Dentists $ 77.00

Oral Surgeons $ 572.00

Podiatrists Surgical $ 1,623.00

Optometrists $ 77.00

Physician Assistant $ 77.00 Other Fees Interest Rate

Administration Fee $ 3.00

Panel Fee for Physicians $ 28.25

Panel Fee Hospital (per occupied bed) $ 6.25 PT/ Resident Panel Interest Class 1 Class 2 Class 3 Class 4 CRNA Retired Moonlighter Fees Rate 1997-98 $2,647 $5,294 $11,382 $15,882 $678 $662 $1,588 $ 32.00 5.2010% 1998-99 $2,721 $5,170 $11,292 $16,326 $678 $680 $1,633 $ 16.00 5.3363% 1999-00 $2,531 $4,809 $10,504 $15,186 $631 $632 $1,519 $ 16.00 4.9650% 2000-01 $1,898 $3,606 $7,877 $11,388 $475 $475 $1,139 $ 38.00 5.1430% 2001-02 $1,538 $2,769 $6,384 $9,231 $378 $385 $923 $ 38.00 6.2150% 2002-03 $1,461 $2,630 $6,063 $8,766 $359 $365 $877 $ 19.00 2.6830% 2003-04 $1,534 $2,761 $6,366 $9,204 $377 $384 $920 $ 19.00 1.5500% 2004-05 $1,227 $2,209 $5,092 $7,362 $302 $307 $736 $ 46.00 1.0250% 2005-06 $859 $1,546 $3,565 $5,154 $211 $215 $515 $ 34.00 1.7890% 2006-07 $1,074 $1,933 $4,457 $6,444 $264 $269 $644 $ 25.00 3.9200% 2007-08 $1,128 $2,030 $4,681 $6,768 $277 $282 $677 $ 17.00 5.2750% 2008-09 $1,128 $2,030 $4,681 $6,768 $277 $282 $677 $ 18.00 4.4350% 2009-10 $1,240 $2,231 $5,144 $7,438 $304 $310 $744 $ 25.00 1.5870% 2010-11 $1,347 $2,423 $5,387 $8,888 $330 $337 $808 $ 28.00 0.2600% 2011-12 $1,461 $2,629 $5,844 $9,643 $358 $365 $877 $ 25.00 0.2130% 2012-13 $1,534 $2,760 $6,136 $10,125 $376 $383 $821 $ 22.50 0.1360% 2013-14 $1,427 $2,626 $5,828 $9,616 $358 $364 $874 $ - 0.1650% 2014-15 $1,311 $2,360 $5,244 $8,653 $323 $328 $787 $ 7.75 0.0910% 2015-16 $865 $1,558 $3,461 $5,711 $213 $216 $519 $ 13.50 0.0950% 2016-17 $606 $1,091 $2,423 $3,998 $149 $151 $363 $7.75 0.2040% 2017-18 $424 $763 $1,696 $2,798 $104 $106 $254 $ 12.75 0.4660% 2018-19 $382 $688 $1,528 $2,521 $94 $95 $229 $ 28.25 1.0610% Fund Staff and Contacts

Billing Mary Moore (608) 266-7525 [email protected] Financial Specialist

Address Changes, Provider Status John Macy (608) 266-6830 [email protected] Program Assistant

Certificates (Primary Insurance) Ana Lopera (608) 264-6227 [email protected] Regulatory Specialist

Fees, Investments Wendy Powers (608) 267-7140 [email protected] Accountant

Fund Statutes and Policies Terri Carlson (608) 267-1237 [email protected] Fund Director