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APPENDIX A <br />HealthLink PM Fees effective .July 1, 2004 <br />$00..50 per Contracted Hour of Coverage. <br /># of Physicians (and mid-level practitioners who provide care under the supervision of a licensed <br />physician, if any) in the Practice: Charged, for 1..5 providers <br />Designated Hours of Coverage per Week: IZI hours per Weelc <br />Effective Start Date of Coverage: January .3, 100.5 <br />Monthly Fee for HealthLink PM services = (Contracted hours per week X # of providers) X 52 <br />(Weeks per year) / 12 (months/year) X $00.50 (cost per hour of coverage per provider). <br />Ill hours per week X 1..5 providers X .52 weeks per,year / Il months per,year X $00..50 = <br />$.392.OOhnonth <br />Optional Holiday coverage for non-contracted hours is available at a rate of $20.00/patient call <br />on the following Holidays only: New Year's Day, Memorial Day, Independence Day, Labor <br />Day, Thanksgiving Day, Christmas Day <br />3/97 <br />