Office visit charges by participating providers will be subject to a $12 $18 copayment by the enrollee, with the balance of covered scheduled allowances paid directly to the provider by the Plan. Effective January 1, 2005, July 1, 2009, office visit charges by participating providers will be subject to a $15 $20 copayment by the enrollee. Effective January 1, 2007, office visit charges by participating providers will be subject to an $18 copayment by the enrollee.

2. All covered surgical procedures performed by participating providers during a visit will be subject to a $12 $18 copayment by the enrollee. Effective January 1, 2005, July 1, 2009, all covered surgical procedures performed by participating providers will be subject to a 15 $20 copayment by the enrollee. Effective January 1, 2007, all covered surgical procedures performed by participating providers will be subject to an $18 copayment by the enrollee.

3. All covered radiology services performed by participating providers during a visit will be subject to a $12 $18 copayment by the enrollee. Effective January 1, 2005, July 1, 2009, all covered radiology services performed by participating providers will be subject to a 15 $20 copayment by the enrollee. Effective January 1, 2007, all covered radiology services performed by participating providers will be subject to an $18 copayment by the enrollee.

4. All covered diagnostic/laboratory services performed by participating providers during a visit will be subject to a $12 $18 copayment by the enrollee. Effective January 1, 2005, July 1, 2009, all covered diagnostic/laboratory services performed by participating providers will be subject to a 15 $20 copayment by the enrollee. Effective January 1, 2007, all covered diagnostic/laboratory services performed by participating providers will be subject to an $18 copayment by the enrollee.

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