Oklahoma Spine Hospital

Charge Code Description Charge UB Code Revenue Code 100001BLADDER SCAN 231761 TREATMENT RM 100002INITIAL OBSERVATION CARE, PER DAY, FOR T 800762 OBSERVATION ROOM 100003OBSERVATION PER HOUR 90762 OBSERVATION ROOM 100008NEGATIVE PRESSURE WOUND THERAPY (EG, VAC 358761 TREATMENT RM 100009PICC LINE 5 YEARS AND OLDER 3915761 TREATMENT RM 10001096374 THERAPEUTIC, PROPHYLACTIC, OR DIAG 433260 IV THERAPY 10001196375 THERAPEUTIC, PROPHYLACTIC, OR DIAG 131260 IV THERAPY 10001296360 INTRAVENOUS INFUSI, HYDR; INITIAL 433260 IV THERAPY 10001396361 INTRAVENOU INFUSION, HYDR; EACH AD 131260 IV THERAPY 10001496372 THERAPEUTIC, PROPHYLACTIC, OR DIAG 215260 IV THERAPY 10001596376 THERAPEUTIC, PROPHYLACTIC, OR DIAG 131260 IV THERAPY 200001OR 61-120 MINUTES 3230360 OR SERVICES 200002OR 1-60 MINUTES 4620360 OR SERVICES 200003OR EACH ADD 15 MIN 1100360 OR SERVICES 200004ANESTHESIA BASE RATE 686370 ANESTHESIA 200005ANESTH EA 15 MIN 174370 ANESTHESIA 300001PACU 1-60 MIN 580710 RECOVERY ROOM 300002PACU 15 MIN 150710 RECOVERY ROOM 300063RECOVERY CHARGE TC400 580710 RECOVERY ROOM 150000196376 IV PUSH NEW DRUG ADD 77.55450 EMERG ROOM 1500002INTMD WND REPAIR N-H 460450 EMERG ROOM 150000396367 TX/PROPH/DG ADDL SEQ 184450 EMERG ROOM 150000496368 THER/DIAG CONCURRENT 184450 EMERG ROOM 150000592950 HEART/LUNG RESUSCIT 819450 EMERG ROOM 150000694640 AIRWAY INHALATION TR 537450 EMERG ROOM 150000751702 INSERTION OF CATH 231450 EMERG ROOM 150000896372 IM/SUB INJECTION 128450 EMERG ROOM 150000996374 IV PUSH MEDS 181450 EMERG ROOM 1500010ER ROOM LEVEL 1 120450 EMERG ROOM 1500011ER ROOM LEVEL II 230450 EMERG ROOM 1500012ER ROOM LEVEL III 350450 EMERG ROOM 1500013ER ROOM LEVEL IV 460450 EMERG ROOM 1500014ER ROOM LEVEL V 580402 ULTRASOUND 150001511730 AVULSION OF NAIL PLATE 358450 EMERG ROOM 150001610160 PUNCTURE DRAINAGE OF LESION 798450 EMERG ROOM 150001796365 TX/PROPH/DG UP TO 1 HOUR 731260 IV THERAPY 150001896366 TX/PROPH/DG EACH ADDL HOUR 135260 IV THERAPY 150001996375 IV PUSH NEW DRUG ADD 106450 EMERG ROOM 150002096361 IV INF HYDRATION EACH ADDL HOUR 131450 EMERG ROOM 150002196523 PICC/PORT FLUSH 124450 EMERG ROOM 150002293005 EKG ED 81450 EMERG ROOM 150002312011 LACERATION REPAIR FACE SIMP 2.5CM 275450 EMERG ROOM 150002410030 DRAIN FLUID COLLECTION 695450 EMERG ROOM 1500025 12001 LACERATION REPAIR EXTRE SIMP 2.5CM 221.45 450 EMERG ROOM 2000001FNA PATH PERFORM WITHOUT IMAGE GU 564300 LABORATORY (LAB) 2000002IMAGE GUI 1600300 LABORATORY (LAB) 2000003VENIPUNCTURE 21300 LABORATORY (LAB) 2000004COLLECTION BLD SPEC 21300 LABORATORY (LAB) 2000005TRANSFUSION PLATELET 2625.49390 BLOOD/STOR-PROC

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000006TRANSFUSION BLOOD 302391 BLOOD/ADMIN 2000007TRANS PLATLET PARTIA 360391 BLOOD/ADMIN 2000008COL BLOOD/IMPLANT DE 72300 LABORATORY (LAB) 2000009COLL BLD VIA IVLINE 199300 LABORATORY (LAB) 2000010ARTERIAL PUNCTURE 91300 LABORATORY (LAB) 2000011BASIC MET PANEL 81.2300 LABORATORY (LAB) 2000012ELECROLYTE PANEL 67.34300 LABORATORY (LAB) 2000013COMP MET PANEL 101.43300 LABORATORY (LAB) 2000014LIPID PANEL 128.59300 LABORATORY (LAB) 2000015RENAL FUNCT PANEL 83.37300 LABORATORY (LAB) 2000016ACUTE HEP PANEL 457.38300 LABORATORY (LAB) 2000017HEPATIC FUNC PANEL 78.47300 LABORATORY (LAB) 2000018DRUG SCR MULTIPLE 51300 LABORATORY (LAB) 2000019CARBAMAZEPINE 139.86300 LABORATORY (LAB) 200002082101 ASSAY OF NICOTINE 434.65300 LABORATORY (LAB) 2000021DIGOXIN (LANOXIN) 127.47300 LABORATORY (LAB) 2000022VALPROIC ACID (DEPAKOTE) 58300 LABORATORY (LAB) 2000023PHENOBARBITAL SERUM 109.97300 LABORATORY (LAB) 2000024DILANTIN 127.26300 LABORATORY (LAB) 2000025THEOPHYLLINE 135.8300 LABORATORY (LAB) 2000026TOBRAMYCIN 154.84300 LABORATORY (LAB) 2000027TOPIRAMATE 114.45300 LABORATORY (LAB) 2000028VANCOMYCIN PEAK 130.06300 LABORATORY (LAB) 2000029AMIODARONE/METABOLI 131.53300 LABORATORY (LAB) 2000030NEURONTIN 131.53300 LABORATORY (LAB) 2000031PATH CONSULT LIMIT 55.8310 PATHOLOGY LAB (PATH LAB) 2000032LAB PATHOLOGY CONSULTATION 56310 PATHOLOGY LAB (PATH LAB) 2000033CHARGE - URINEWITHMICROSCOPI 30.45300 LABORATORY (LAB) 2000034CHARGE- URINALYSIS 21.56300 LABORATORY (LAB) 2000035ACTH 370.86300 LABORATORY (LAB) 2000036ALBUMIN SERUM 47.53300 LABORATORY (LAB) 2000037ALBUMIN URINE 55.51300 LABORATORY (LAB) 2000038ALCOHOL URI/SER/BLD 65300 LABORATORY (LAB) 2000039A-1 ANTI TRYPSIN 129.01300 LABORATORY (LAB) 2000040AMONIA PLASMA 139.93300 LABORATORY (LAB) 2000041AMYLASE 62.23300 LABORATORY (LAB) 2000042BILIRUBIN TOTAL 48.16300 LABORATORY (LAB) 2000043DIRECT BILIRUBIN 48.16300 LABORATORY (LAB) 2000044OCCULT BLOOD 31.22300 LABORATORY (LAB) 2000045GASTRIC FLIED FOR OCCULT BLOOD 31.22300 LABORATORY (LAB) 2000046VITAMIN D3 25-OH 284.27300 LABORATORY (LAB) 2000047CALCIUM IONIZED ISTAT 131.32300 LABORATORY (LAB) 2000048IONIZED CALCIUM I STAT 131.32300 LABORATORY (LAB) 2000049CALCULUS ANALYSIS QUAL 111.16300 LABORATORY (LAB) 2000050CALCULUS SPECTROSCOPY 123.83300 LABORATORY (LAB) 2000051CARBON DIOXIDE 46.9300 LABORATORY (LAB) 2000052CARBON MONOXIDE TEST 57.54300 LABORATORY (LAB) 2000053CARCINO EMBRYONIC ANTIGEN 182.07300 LABORATORY (LAB) 2000054CERULOPLASMIN 103.11300 LABORATORY (LAB) 2000055CHLORIDE 39.55300 LABORATORY (LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000056CALCIUM 49.56300 LABORATORY (LAB) 2000057SERUM CHOLESTEROL 41.79300 LABORATORY (LAB) 2000058CORTISOL SERUM 156.52300 LABORATORY (LAB) 2000059CK TOTAL 62.51300 LABORATORY (LAB) 2000060CPK ISOENZYMES 128.59300 LABORATORY (LAB) 2000061CK MB & CK TOTAL 110.88300 LABORATORY (LAB) 2000062CREATININE 49.21300 LABORATORY (LAB) 2000063CREATININE EXCLUDING BLOOD 49.7300 LABORATORY (LAB) 2000064VITAMIN B12 144.76300 LABORATORY (LAB) 2000065DHEA-S 213.5300 LABORATORY (LAB) 2000066VITAMIN D 1 25 DIOH 268.9300 LABORATORY (LAB) 2000067ESTRADIOL 268.24300 LABORATORY (LAB) 2000068ESTROGEN 208.32300 LABORATORY (LAB) 2000069FERRITIN 130.9300 LABORATORY (LAB) 2000070FOLIC ACID SERUM 141.19300 LABORATORY (LAB) 2000071GAMMAGLOBULIN IGG 89.32300 LABORATORY (LAB) 2000072GAMMAGLOBULIN IGM 89.32300 LABORATORY (LAB) 2000073GAMMAGLOBULIN IGE 158.06300 LABORATORY (LAB) 2000074I STAT 185.78300 LABORATORY (LAB) 2000075ARTERIAL BLOOD GAS 272.44300 LABORATORY (LAB) 2000076GLUCOSE FASTING 37.73300 LABORATORY (LAB) 2000077GLUCOSE RANDOM 37.73300 LABORATORY (LAB) 2000078GLUCOSE FLUID 37.73300 LABORATORY (LAB) 2000079GLUCOSE ISTAT 37.73300 LABORATORY (LAB) 2000080FINGERSTICK 22.47300 LABORATORY (LAB) 2000081GGT 69.16300 LABORATORY (LAB) 2000082FSH 178.43300 LABORATORY (LAB) 2000083LUTENIZING HORMONE 177.8300 LABORATORY (LAB) 2000084HUMAN GROWTH HORMONE 160.09300 LABORATORY (LAB) 2000085HEMOGLOBIN ELECTROPHORESIS 123.62300 LABORATORY (LAB) 2000086HEMOGLOBIN A1C 82.95300 LABORATORY (LAB) 2000087HOMOCYSTINE 161.98300 LABORATORY (LAB) 2000088EGFR 49.21310 PATHOLOGY LAB (PATH LAB) 2000089INSULIN TOTAL 109.76300 LABORATORY (LAB) 2000090IRON 53.48300 LABORATORY (LAB) 2000091IRON BINDING CPCY 83.93300 LABORATORY (LAB) 2000092LACTIC ACID 102.55300 LABORATORY (LAB) 2000093LDH PERITONEAL FLUID 57.96300 LABORATORY (LAB) 2000094LDH 57.96300 LABORATORY (LAB) 2000095LDH ISOENZYMES 122.85300 LABORATORY (LAB) 2000096LIPASE SERUM 66.15300 LABORATORY (LAB) 2000097HIGH DENSITY LIPOPROTEIN 78.68300 LABORATORY (LAB) 2000098DIRECT LDL 91.63300 LABORATORY (LAB) 2000099MAGNESIUM 64.33300 LABORATORY (LAB) 200010010 HYDROXYCARBAZEPIN 173.39300 LABORATORY (LAB) 2000101MUCIN CLOT 56.28300 LABORATORY (LAB) 2000102MYELIN PROTEIN 165.2300 LABORATORY (LAB) 2000103MYOGLOBIN URINE 124.04300 LABORATORY (LAB) 2000104B-TYPE NATRIURETIC 325.92300 LABORATORY (LAB) 2000105NEPHELOMTRY NOS 130.55300 LABORATORY (LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000106NICOTINE 823.55300 LABORATORY (LAB) 2000107MOLECULE ISOLATE 56300 LABORATORY (LAB) 2000108ISOLATN/EXT NUC ACID 28300 LABORATORY (LAB) 2000109ENZYMATIC DIGESTION 28.4300 LABORATORY (LAB) 2000110MOLECULE DOT/SLOT/BL 28300 LABORATORY (LAB) 2000111SEP BY GEL ELECTROPH 56300 LABORATORY (LAB) 2000112MOLECULAR DIAGNOSTIC 56300 LABORATORY (LAB) 2000113MOLECULE NUCLEIC AMP 117.1300 LABORATORY (LAB) 2000114MOLEC DIAG AMPLIFICA 237.4300 LABORATORY (LAB) 2000115MOLEC DIAG EACH ADD 118.7300 LABORATORY (LAB) 2000116MOLEC DIAG SEPAR AND 118.7300 LABORATORY (LAB) 2000117GENETIC EXAM 56300 LABORATORY (LAB) 2000118MUTATION IDENTIFICAT 118.7300 LABORATORY (LAB) 2000119OLIGOCLONAL BANDS 193.13300 LABORATORY (LAB) 2000120OSMOLALITY SERUM 63.49300 LABORATORY (LAB) 2000121OSMOLALITY URINE 65.45300 LABORATORY (LAB) 2000122PARATHYROID HORMONE 396.34300 LABORATORY (LAB) 2000123VANCOMYCIN TROUGH 130.06300 LABORATORY (LAB) 2000124PH BODY FLUID EXC BLD 34.37300 LABORATORY (LAB) 2000125PROSTATIC ACID PHOS 92.75300 LABORATORY (LAB) 2000126ALKALINE PHOSPHATASE 49.7300 LABORATORY (LAB) 2000127ALKALINE PHOSPHATASE ISOENZYMES 141.99300 LABORATORY (LAB) 2000128PHOS INORG SERUM 45.5300 LABORATORY (LAB) 2000129POTASSIUM 44.17300 LABORATORY (LAB) 2000130POTASSIUM ISTAT 44.17300 LABORATORY (LAB) 2000131PREALBUMIN 140.07300 LABORATORY (LAB) 2000132PREGNENOLONE 198.52300 LABORATORY (LAB) 2000133PROGESTERONE 200.34300 LABORATORY (LAB) 2000134PROLACTIN 186.06300 LABORATORY (LAB) 2000135PROTEIN 35.21300 LABORATORY (LAB) 200013624 HOUR URINE FOR PROTEIN 35.21300 LABORATORY (LAB) 2000137RANDOM URINE PROTEIN 35.21300 LABORATORY (LAB) 2000138PROTEIN CSF 35.21300 LABORATORY (LAB) 2000139PROTEIN BODY FLUID 35.21300 LABORATORY (LAB) 2000141PROTEIN PERITONEAL F 35.21300 LABORATORY (LAB) 2000142VITAMIN B6 269.78300 LABORATORY (LAB) 2000143RENIN 211.19300 LABORATORY (LAB) 2000144SODIUM SERUM 46.2300 LABORATORY (LAB) 2000145SODIUM ISTAT 46.2300 LABORATORY (LAB) 2000146SODIUM URINE RANDOM 46.69300 LABORATORY (LAB) 2000147IGF1 204.19300 LABORATORY (LAB) 2000148SPECIFIC GRAVITY NOT URINE 24.08300 LABORATORY (LAB) 2000149TESTERONE FREE 244.58300 LABORATORY (LAB) 2000150TESTOSTERONE 247.87300 LABORATORY (LAB) 2000151T4 TOTAL 65.94300 LABORATORY (LAB) 2000152T4 FREE 86.59300 LABORATORY (LAB) 2000153TSH 161.35300 LABORATORY (LAB) 2000154SGOT (AST) 49.7300 LABORATORY (LAB) 2000155SGPT (ALTV) 50.89301 LAB/CHEMISTRY 2000156TRIGLYCERIDE 55.16301 LAB/CHEMISTRY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000157T3 UPTAKE 62.09300 LABORATORY (LAB) 2000158T3 TOTAL 136.15300 LABORATORY (LAB) 2000159T3 FREE 162.68300 LABORATORY (LAB) 2000160ISTAT TROPONIN 94.5300 LABORATORY (LAB) 2000161BLOOD UREA NITROGEN 37.94300 LABORATORY (LAB) 2000162URIC ACID 43.4300 LABORATORY (LAB) 2000163ALCOHOL METHANOL BLOOD 154.42300 LABORATORY (LAB) 2000164HCG QUANTITATIVE 144.55300 LABORATORY (LAB) 2000165HCG URINE QUAL 72.24300 LABORATORY (LAB) 2000166HCG SERUM QUALITATIVE 72.24300 LABORATORY (LAB) 2000167FECAL REDUCING SUBSTANCE 73300 LABORATORY (LAB) 2000168HH ISTAT 22.75300 LABORATORY (LAB) 2000169HEMATOCRIT 22.75300 LABORATORY (LAB) 2000170HEMOGLOBIN BLOOD 22.75300 LABORATORY (LAB) 2000171CHARGE CBC/PLATELETS/RDW 74.62300 LABORATORY (LAB) 2000172CHARGE- HEMOGRAM 62.09300 LABORATORY (LAB) 2000173RED BLOOD CELL COUNT 28.98300 LABORATORY (LAB) 2000174RETICULOCYTE COUNT 38.36300 LABORATORY (LAB) 2000175WBC 24.36300 LABORATORY (LAB) 2000176PLATELET AUTOMATED 42.98300 LABORATORY (LAB) 2000177BLOOD SMEAR INTERPRETATION 184305 LAB/HEMOTOLOGY 2000178BONE MARROW INTERPRETATION 184300 LABORATORY (LAB) 2000179D-DIMER 97.72300 LABORATORY (LAB) 2000180FIBRINOGEN 81.55300 LABORATORY (LAB) 2000181FIBRINOGEN ANTIGEN 81.55300 LABORATORY (LAB) 2000182PLT FUNCTION ASPIRIN 206.29300 LABORATORY (LAB) 2000183PLT FUNCTION P2Y12 206.29300 LABORATORY (LAB) 2000184PROTIME 37.73300 LABORATORY (LAB) 2000185SED RATE WESTERGRN 34.09300 LABORATORY (LAB) 2000186SICKLE CELL SCREEN 52.92300 LABORATORY (LAB) 2000187APTT 57.68300 LABORATORY (LAB) 2000188ANA SCREEN 116.06300 LABORATORY (LAB) 2000189ASO QUANTITATIVE 70.07300 LABORATORY (LAB) 2000190CRP QUANT 49.7300 LABORATORY (LAB) 2000191CARDIOLIPIN AB IGGI 244.37300 LABORATORY (LAB) 2000192COMPLEMENT C4 115.22300 LABORATORY (LAB) 2000193COMPLEMENT C3 115.22300 LABORATORY (LAB) 2000194COMP TOT CH50 195.16300 LABORATORY (LAB) 2000195CA125 199.85300 LABORATORY (LAB) 2000196PROSTATE SPEC AG 199.85300 LABORATORY (LAB) 2000197NICOTINE 823.55300 LABORATORY (LAB) 2000198THYROID PEROXI ANTI 139.72300 LABORATORY (LAB) 2000199RHEUMATOID QUAL 54.46300 LABORATORY (LAB) 2000200RHEUMATOID ARTHRITIS DIAG PANEL 54.46300 LABORATORY (LAB) 2000201RHEUMATOID QUANT 54.46300 LABORATORY (LAB) 2000202PREMATERIAL SEROLOG 41.02300 LABORATORY (LAB) 2000203CSFVDRL 41.02300 LABORATORY (LAB) 2000204CYTOMEGALOVIRUS IGM 161.77300 LABORATORY (LAB) 2000205COXSACKIE PANEL 125.09300 LABORATORY (LAB) 2000206EPSTEIN BARR VIRUS 115300 LABORATORY (LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000207HELICOBACTER PYLORI 139.3300 LABORATORY (LAB) 2000208SEROLOGICAL MISC CONFIRMATION 185.85300 LABORATORY (LAB) 2000209HIV 1& 2 SGL ASSAY 231.21300 LABORATORY (LAB) 2000210HEPATITIS B CORE ANTIBODY 115.71300 LABORATORY (LAB) 2000211HEPATITIS B CORE ANTIBODY IGM 113.05300 LABORATORY (LAB) 2000212HEP B SURF ANTIBDY 103.11300 LABORATORY (LAB) 2000213HEPATITIS BE ANTIBODY 111.09300 LABORATORY (LAB) 2000214HEP A ANTIBODY 118.93300 LABORATORY (LAB) 2000215MUMPS IGG 125.3300 LABORATORY (LAB) 2000216HUMAN PARVOVIRUS B19 144.34300 LABORATORY (LAB) 2000217ROCKY MOUNTAIN SPOTTED FEVER 185.85300 LABORATORY (LAB) 2000218RUBELLA ANTIBODY IGG 138.18300 LABORATORY (LAB) 2000219RUBEOLA ANTIBODY IGM 123.69300 LABORATORY (LAB) 2000220RUBEOLA ANTIBODY IGG 123.69300 LABORATORY (LAB) 2000221VARICELLA ZOSTER TITER 123.69300 LABORATORY (LAB) 2000222HUMAN HERPES V 6 IGG 109.97300 LABORATORY (LAB) 2000223HEP C ANTIBODY 136.99300 LABORATORY (LAB) 2000224HEPATITIS C ANTIBODY RIBA 148.75300 LABORATORY (LAB) 2000225HLA B27 240.24300 LABORATORY (LAB) 2000226ANTIBODY ELUTION 204300 LABORATORY (LAB) 2000227ANTIBODY IDENTIFIC 255300 LABORATORY (LAB) 2000228RED CELL PANEL ADD'L ANTIBODY ID 152300 LABORATORY (LAB) 2000229DIRECT ANTIGLOBULIN 51.73300 LABORATORY (LAB) 2000230BB COOMBS INDIRECT 54.95300 LABORATORY (LAB) 2000231AUTOLOGOUS RED BLD C 550300 LABORATORY (LAB) 2000232AUTO BLOOD SALVAGE 107.1300 LABORATORY (LAB) 2000233BB BLOOD TYPING ABO 28.7300 LABORATORY (LAB) 2000234BB BLOOD TYPING RH 28.7300 LABORATORY (LAB) 2000235ANTIGEN SCREENING 36.75300 LABORATORY (LAB) 2000236FYA ANTIGEN TYPE 152300 LABORATORY (LAB) 2000237FYB ANTIGEN TYPE 152300 LABORATORY (LAB) 2000238JKA ANTIGEN TYPE 152300 LABORATORY (LAB) 2000239JKB ANTIGEN TYPE 152300 LABORATORY (LAB) 2000240K ANTIGEN TYPE 152300 LABORATORY (LAB) 2000241LEA ANTIGEN TYPE 152300 LABORATORY (LAB) 2000242LEB ANTIGEN TYPE 152300 LABORATORY (LAB) 2000243M ANTIGEN TYPE 152300 LABORATORY (LAB) 2000244N ANTIGEN TYPE 152300 LABORATORY (LAB) 2000245S ANTIGEN TYPE 152300 LABORATORY (LAB) 2000246P1 ANTIGEN TYPE 152300 LABORATORY (LAB) 2000247C ANTIGEN TYPE 152300 LABORATORY (LAB) 2000248E ANTIGEN TYPE 152300 LABORATORY (LAB) 2000249DTT SERUM PRETREATME 152300 LABORATORY (LAB) 2000250C ANTIGEN TYPE (LC) 152300 LABORATORY (LAB) 2000251E ANTIGEN TYPE (LC) 152300 LABORATORY (LAB) 2000252S ANTIGEN TYPE (LC) 152300 LABORATORY (LAB) 2000253LOWERCASE K ANTIGEN TYPE 152300 LABORATORY (LAB) 2000254ANTI A1 LECHTIN 152300 LABORATORY (LAB) 2000255BB CROSSMATCH X 1 185300 LABORATORY (LAB) 2000256MARIJUANA LEVEL 148300 LABORATORY (LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000257 CULT TUBERCLE OR OTHER ACID-FAST BACILLI 66.7300 LABORATORY (LAB) 2000258FAST STAIN SMEAR 33.25300 LABORATORY (LAB) 2000260FFP/CRYO THAW 354300 LABORATORY (LAB) 2000261BLOOD FROZEN W/FREEZE/THAW 585302 LAB IMMUNOLOGY 2000262CONCENTRATION OF INFECTION AG 62.65300 LABORATORY (LAB) 2000263CULTURE BLOOD 99.12300 LABORATORY (LAB) 2000264CULTURE MISC 82.74300 LABORATORY (LAB) 2000265CULT AEROBE 82.74300 LABORATORY (LAB) 2000266ANAEROBE CULTURE 90.93300 LABORATORY (LAB) 2000267ORGANISM IDENTIFICATION 77.56300 LABORATORY (LAB) 2000268CULTURE URINE 77.49300 LABORATORY (LAB) 2000270ORGANISM ID URINE 59.08300 LABORATORY (LAB) 2000271FUNGUS SKIN CULTURE 73.29300 LABORATORY (LAB) 2000272FUNGUS CULTURE 80.71300 LABORATORY (LAB) 2000273CULTURE BLOOD FUNGUS 86.59300 LABORATORY (LAB) 2000274FUNGUS ID 99.12300 LABORATORY (LAB) 2000275ORGANISM IDENTIFICATION M 99.12300 LABORATORY (LAB) 2000276MYCOPLASMA CULTURE 147.77300 LABORATORY (LAB) 2000278ORGANISM ID STERTYPI 49.7300 LABORATORY (LAB) 2000280SUSCEPT YEAST COMP PANEL 83.02300 LABORATORY (LAB) 2000281CULT SENS MIC 83.02300 LABORATORY (LAB) 2000282GRAM SMEAR 41.02300 LABORATORY (LAB) 2000284C. DIFF A AND B EIA 310.31300 LABORATORY (LAB) 2000285HEPATITIS B ANTIGEN 99.19300 LABORATORY (LAB) 2000286HEPATITIS B SURGACE ANTIGEN 99.19300 LABORATORY (LAB) 2000287HEPATITIS C VIRUS RNA QUANT PCR 411.32300 LABORATORY (LAB) 2000288MYCOBACTRIUM TB BY PCR 336.98300 LABORATORY (LAB) 2000289MRSA BY PCU 336.98300 LABORATORY (LAB) 2000290RAPID INFLUENZA TEST 115.08300 LABORATORY (LAB) 2000291CYTOPATH FL NONGYN SMEARS 222.6310 PATHOLOGY LAB (PATH LAB) 2000292CYTOPATH CONCENTRATE 222.6310 PATHOLOGY LAB (PATH LAB) 2000293CYTP DX EVAL FNA 1ST EA SITE 86311 CYTOLOGY TESTS 2000294CYTOPATH EVAL FNA REPORT 184311 CYTOLOGY TESTS 2000295CYTOLOGY TECHNICAL 86311 CYTOLOGY TESTS 2000296CYTOLOGY ADD MARKER 86311 CYTOLOGY TESTS 2000297INTERP 2-8 MARKERS 56311 CYTOLOGY TESTS 2000298INTERP 9-15 MARKERS 184311 CYTOLOGY TESTS 2000299INTERP 16 OR MORE MARKERS 203311 CYTOLOGY TESTS 2000300SURGICAL PATH LEVELI 55.8310 PATHOLOGY LAB (PATH LAB) 2000301TISSUE EXAM BY PATHOLOGIST II 203310 PATHOLOGY LAB (PATH LAB) 2000302TISSUE EXAM BY PATHOLOGIST III 184.05310 PATHOLOGY LAB (PATH LAB) 2000303TISSUE EXAM LEVEL IV 184.05310 PATHOLOGY LAB (PATH LAB) 2000304TISSUE EXAM LEVEL V 288.3310 PATHOLOGY LAB (PATH LAB) 2000305TISSUE EXAM BY PATHOLOGIST VI 288.3310 PATHOLOGY LAB (PATH LAB) 2000306DECALCIFY TISSUE 55.8310 PATHOLOGY LAB (PATH LAB) 2000307SPECIAL STAINS GROUP 1 85.4310 PATHOLOGY LAB (PATH LAB) 2000308SPECIAL STAINS GROUP 2 85.4310 PATHOLOGY LAB (PATH LAB) 2000309MICROSLIDE CONSULTATION 85.4310 PATHOLOGY LAB (PATH LAB) 2000310MICROSLIDE CONSULTATION 184.05310 PATHOLOGY LAB (PATH LAB) 2000311PATH CONSULT 288.3310 PATHOLOGY LAB (PATH LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000312PATH CONSULT INTRA OPERATIVE 85.4310 PATHOLOGY LAB (PATH LAB) 2000313PATH CONSULT INTRAOP 1 SECTION 184.05310 PATHOLOGY LAB (PATH LAB) 2000314PATH CONSULT ADDITIONAL SECTION 55.05310 PATHOLOGY LAB (PATH LAB) 2000315INTRAOP CYTO PATH CONSULT 1 85.4310 PATHOLOGY LAB (PATH LAB) 2000316INTRAOP CYTO PATH CONSULT 2 85.4310 PATHOLOGY LAB (PATH LAB) 2000317IMMUNOHISTOCHEMISTRY 184.05310 PATHOLOGY LAB (PATH LAB) 2000318ANALYSIS TUMOR 184.05310 PATHOLOGY LAB (PATH LAB) 2000319TUMOR IMMUNOHISTOCHEM/MANUAL 288.3310 PATHOLOGY LAB (PATH LAB) 2000320TUMOR IMMUNOHISTOCHEM/COMPUT 288.3300 LABORATORY (LAB) 2000321XM ARCHIVE TISSUE MOLEC ANAL 55.8310 PATHOLOGY LAB (PATH LAB) 2000322INSITU HYBRIDIZATION 288.3310 PATHOLOGY LAB (PATH LAB) 2000323INSITU HYBRIDIZATION AUTO 250310 PATHOLOGY LAB (PATH LAB) 2000324INSUTU HYBRIDIZATION MANUAL 288.3310 PATHOLOGY LAB (PATH LAB) 2000325CELL COUNT/DIFF 52.85300 LABORATORY (LAB) 2000326BODY FLUID CELL COUNT & DIFF 52.85300 LABORATORY (LAB) 2000327CRYSTAL EXM JOINT 68.67300 LABORATORY (LAB) 2000328NASAL EOSINOPHIL 45.57300 LABORATORY (LAB) 2000337BB CROSSMATCH X 2 185300 LABORATORY (LAB) 2000338BB CROSSMATCH X 3 185300 LABORATORY (LAB) 2000339BB CROSSMATCH X 4 185300 LABORATORY (LAB) 2000342CYTOLOGY ON BLOOD SPECIMEN 918.12300 LABORATORY (LAB) 2000344EGFR 49.21310 PATHOLOGY LAB (PATH LAB) 2000347HEPATITIS A ANTIBODY IGM 112300 LABORATORY (LAB) 2000352LIPROTEIN ELECTROPHORESIS 71300 LABORATORY (LAB) 2000353LYME PANEL BASIC 148.75300 LABORATORY (LAB) 2000354MANUAL DIFFERENTIAL 32.97300 LABORATORY (LAB) 2000357RED BLOOD UNIT 475390 BLOOD/STOR-PROC 2000358CRYOPRECIPITATE 500390 BLOOD/STOR-PROC 2000359FRESH FROZEN PLASMA 399383 BLOOD/PLASMA 2000360FROZN PLASMA 24 HRS 383.85390 BLOOD/STOR-PROC 2000363RUBELLA ANTIBODY IGM 73300 LABORATORY (LAB) 2000365BARTONELLA TITERS IGG IGM 88.13300 LABORATORY (LAB) 2000367 PROTIEN, ELECTROPHORETIC FRACTIONATION A 103.11 300 LABORATORY (LAB) 2000368 CYCKUC CITRULLNATED PEPTIDE ( CCP), ANTI 124.32 300 LABORATORY (LAB) 2000369 ANTIBODY; EPSTEIN-BARR (EB) VIRUS, NUCLE 146.86 300 LABORATORY (LAB) 2000370 ANTIBODY; EPSTEIN-BARR (EB) VIRUS, VIRAL 174.23 300 LABORATORY (LAB) 2000371 CULTURE, BACTERIAL; STOOL, AEROBIC, W IS 90.65 300 LABORATORY (LAB) 2000372 CULTURE, BACTERIAL; STOOL, AEROBIC,ADDIT 90.65 300 LABORATORY (LAB) 2000373 INFECTIOUS AGENT ANTIGEN DETECTION BY EN 115.08 300 LABORATORY (LAB) 2000374 OVA AND PARASITES, DIRECT SMEARS, CONCEN 83.93 300 LABORATORY (LAB) 2000375 SMEAR, PRIMARY SOURCE W INTERPRETATION; 172.62 300 LABORATORY (LAB) 2000376 ALBUMIN; URINE OR OTHER SOURCE, QUANTITA 49.7 300 LABORATORY (LAB) 2000378ISTAT CHEMISTRY PROFILE 259.42300 LABORATORY (LAB) 2000379FINGER STICK BLOOD SUGAR (POCG) 22.47300 LABORATORY (LAB) 2000381CYTOCHROME P450 2C9 2053.8310 PATHOLOGY LAB (PATH LAB) 2000382CYTOCHROME P450 2D6 3178.49310 PATHOLOGY LAB (PATH LAB) 2000383HLA AB PANEL 1069.32310 PATHOLOGY LAB (PATH LAB) 2000384HLA DRB, DRQ 1187.62310 PATHOLOGY LAB (PATH LAB) 2000385FACTOR V LEIDEN 586.74310 PATHOLOGY LAB (PATH LAB) 2000386ODNA 55310 PATHOLOGY LAB (PATH LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000387PRBC 725310 PATHOLOGY LAB (PATH LAB) 2000392 PROTHROMBIN TIME; SUBSTITUTION, PLASMA F 37.87 300 LABORATORY (LAB) 2000393 THROMBOPLASTIN TIME, PARTIAL (PTT); SUBS 62.09 300 LABORATORY (LAB) 2000394 QUANTITATION OF DRUG, NOT ELSEWHERE SPEC 131.53 300 LABORATORY (LAB) 2000395 ANTIBODY; BORRELIA BURGDORFERI (LYME DIS 148.75 300 LABORATORY (LAB) 2000396MRSA MSSA SCREEN 63.63300 LABORATORY (LAB) 2000397A1 TYPE 36.75300 LABORATORY (LAB) 2000400OXYCODONE LEVEL 159300 LABORATORY (LAB) 2000401AMPHETAMINE OR METHAMPHETAMINE 187300 LABORATORY (LAB) 2000402BARBITURATE 187300 LABORATORY (LAB) 2000403QUANT SINGLE AND MOBILE PHASE 173.39300 LABORATORY (LAB) 2000404COCAINE OR METABOLITE 187300 LABORATORY (LAB) 2000405METHADONE 187300 LABORATORY (LAB) 2000406OPIATES AND METABOLITES 187300 LABORATORY (LAB) 2000407PCP 141.19300 LABORATORY (LAB) 2000409DRUG SCREEN SINGLE 25300 LABORATORY (LAB) 2000410SPECTROPHOTOMETRY 67.13300 LABORATORY (LAB) 2000411MITOCHONDRIAL ANTIBODY 115.71300 LABORATORY (LAB) 2000412PORPHYRINS 432300 LABORATORY (LAB) 2000413CHROMOTOGRAPHY QUANT SING 188300 LABORATORY (LAB) 2000414ASSAY OF BENZODIAZEPINES 188300 LABORATORY (LAB) 2000415ASSAY OF AMITRIPTYLINE 188300 LABORATORY (LAB) 2000416ASSAY OF DIHYDROCODEINONE 188300 LABORATORY (LAB) 2000417ASSAY OF DIHYDROMORPHINONE 188300 LABORATORY (LAB) 2000418ASSAY OF MEPROBAMATE 188300 LABORATORY (LAB) 2000419MASS SPECTROMETRY QUANT 173.39300 LABORATORY (LAB) 2000420 CHARGE - URINALYSIS NONAUTO W/O SCOPE 22.47 300 LABORATORY (LAB) 2000421WAIVED DRUG SCREEN 100300 LABORATORY (LAB) 2000422ASSAY OF URINE CREATININE 49.7300 LABORATORY (LAB) 2000424ASSAY OF AMITRIPTYLINE 107.26300 LABORATORY (LAB) 2000425ASSAY OF BENZODIAZEPINES 17.85300 LABORATORY (LAB) 2000426ASSAY OF ETHANOL 107.14300 LABORATORY (LAB) 2000427ASSAY OF AMPHETAMINES 53.57300 LABORATORY (LAB) 2000428 COLUMN CHROMATOGRAPHY/MASS SPECTROMETRY 173.39 300 LABORATORY (LAB) 2000429ASSAY OF COCAINE 107.14300 LABORATORY (LAB) 2000430COLUMN CHROMOTOGRAPHY QUANT 173.39300 LABORATORY (LAB) 2000431ASSAY OF DIHYDROCODEINONE 53.57300 LABORATORY (LAB) 2000432ASSAY OF DIHYDROMORPHINONE 107.14300 LABORATORY (LAB) 2000433MASS SPECTROMETRY QUANT 173.39300 LABORATORY (LAB) 2000434ASSAY OF MEPROBAMATE 53.57300 LABORATORY (LAB) 2000435ASSAY OF METHADONE 107.14300 LABORATORY (LAB) 2000436ASSAY OF OPIATES 53.57300 LABORATORY (LAB) 2000437ASSAY FOR PHENCYCLIDINE 141.19300 LABORATORY (LAB) 2000439ASSAY OF BENZODIAZEPINES 188300 LABORATORY (LAB) 2000440ASSAY OF BENZODIAZEPINES 17.85300 LABORATORY (LAB) 2000441ASSAY OF ETHANOL 65300 LABORATORY (LAB) 2000442ASSAY OF ETHANOL 107.14300 LABORATORY (LAB) 2000443ASSAY OF BARBITURATES 187300 LABORATORY (LAB) 2000444ASSAY OF COCAINE 187300 LABORATORY (LAB) 2000445ASSAY OF COCAINE 107.14300 LABORATORY (LAB)

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

2000446ASSAY OF DIHYDROCODEINONE 188300 LABORATORY (LAB) 2000447ASSAY OF DIHYDROCODEINONE 53.57300 LABORATORY (LAB) 2000448ASSAY OF DIHYDROCODEINONE 188300 LABORATORY (LAB) 2000449ASSAY OF DIHYDROCODEINONE 107.14300 LABORATORY (LAB) 2000450ASSAY OF MEPROBAMATE 188300 LABORATORY (LAB) 2000451ASSAY OF MEPROBAMATE 53.57300 LABORATORY (LAB) 2000452ASSAY OF METHADONE 187300 LABORATORY (LAB) 2000453ASSAY OF METHADONE 107.14300 LABORATORY (LAB) 2000454ASSAY OF NICOTINE 165.45300 LABORATORY (LAB) 2000455ASSAY OF DIHYDROCODEINONE 187300 LABORATORY (LAB) 2000456ASSAY OF DIHYDROCODEINONE 53.57300 LABORATORY (LAB) 2000457 ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYC 188 300 LABORATORY (LAB) 2000458 ANTIDEPRESSANTS, TRICYCLIC AND OTHER CYC 107.26 300 LABORATORY (LAB) 2000459AMPHETAMINES, 1 OR 2 187300 LABORATORY (LAB) 2000460AMPHETAMINES, 1 OR 2 53.57300 LABORATORY (LAB) 2000461FIBRIN DEGRADATION PRODUCTS 59.08300 LABORATORY (LAB) 2000462COCCIDIOIDES ANTIBODY 110.18300 LABORATORY (LAB) 2000463ASSAY OF GENTAMICIN 157.29300 LABORATORY (LAB) 2000465EHRLICHIA CHAFFEENIS (IGG, IGM) 88.13300 LABORATORY (LAB) 2000466RARE ANTISERA 412.08300 LABORATORY (LAB) 2000467BETA-2-TRANSFERRIN 281.82300 LABORATORY (LAB) 2000468CULTURE, VIRAL, BODY FLUIDS 250.32300 LABORATORY (LAB) 2000469 CRYPTOCOCCAL ANTIGEN WITH REFLEX TO TITE 97.86 300 LABORATORY (LAB) 2000470IGA LEVEL 89.32300 LABORATORY (LAB) 2000471RED BLOOD CELL WASHING FEE 813.4381 BLOOD/PKD RED 2000472AMINOLEVULINIC ACID, DELTA 157.99300 LABORATORY (LAB) 2000473EACH MULTIPLEX STAIN PROCEDURE 770300 LABORATORY (LAB) 2000475RBC PRETREATMENT SERUM 50.48300 LABORATORY (LAB) 2000476QUANTIFERON GOLD TB 595.14300 LABORATORY (LAB) 2000477VARICELLA ZOSTER ANTIBODY IGM 111.3300 LABORATORY (LAB) 2000478NICOTINE SERUM / PLASMA 434.65300 LABORATORY (LAB) 2000479TRANSFERRIN 110.32300 LABORATORY (LAB) 2000480DRUG SCREEN MED MATCH 823.55300 LABORATORY (LAB) 2000481METHAMPHETAMINE ISOMER 187300 LABORATORY (LAB) 2000482TRAMADOL 187300 LABORATORY (LAB) 2000483RCOVID 300300 LABORATORY (LAB) 2000484SARSCOV2 COVID19 IGG/IGM SCREENING 153300 LABORATORY (LAB) 2000485MS PANEL 637300 LABORATORY (LAB) 2001009HEMOGRAM 62.09300 LABORATORY (LAB) 2001020RCBC 74.62300 LABORATORY (LAB) 2001021RBMP 81.2300 LABORATORY (LAB) 2001022RCMP 101.43300 LABORATORY (LAB) 2001023RPT 37.73300 LABORATORY (LAB) 2001024RPTT 57.68300 LABORATORY (LAB) 2001025RTROPONIN 94.5300 LABORATORY (LAB) 3000001XR EYE SCREEN 234320 RADIOLOGY 3000002XR MAND 1-3V 254320 RADIOLOGY 3000003XR FACE 3V 254320 RADIOLOGY 3000004XR NASAL 1-3V 254320 RADIOLOGY 3000005XR ORBIT 4V 300320 RADIOLOGY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3000006XR SINUS1-2V 234320 RADIOLOGY 3000007XR SINUS 3V 303320 RADIOLOGY 3000008XR SKULL1-3V 303320 RADIOLOGY 3000009XR SKULL 4V 396320 RADIOLOGY 3000010XR CHEST 1V 252320 RADIOLOGY 3000011XR CHEST 2V 272320 RADIOLOGY 300001272090 XR SCOLI 2-3V 469320 RADIOLOGY 3000013XR RIB RT 2V 234320 RADIOLOGY 3000014XR RIB RT 3V 303320 RADIOLOGY 3000015XR RIBS BIL 3V 354320 RADIOLOGY 3000016XR RIBS BIL 4V 396320 RADIOLOGY 3000017XR STERNUM 2V 234320 RADIOLOGY 3000018XR STCJ 3V 303320 RADIOLOGY 3000019XR SPINE 1V 263320 RADIOLOGY 3000020XR C-SP 2-3V 303320 RADIOLOGY 3000021XR C-SP 4V 396320 RADIOLOGY 3000022XR C-SP 6V 396320 RADIOLOGY 3000023XR SCOLI 1V 469320 RADIOLOGY 3000024XR T-SP 2V 234320 RADIOLOGY 3000025XR T-SP 3V 254320 RADIOLOGY 3000026XR T-SP 4V 303320 RADIOLOGY 3000027XR T-L 2V 234320 RADIOLOGY 3000028XR L-SP 2-3V 303320 RADIOLOGY 3000029XR L-SP 4V 396320 RADIOLOGY 3000030XR L-SP 6V 396320 RADIOLOGY 3000031XR L-SP BEND 2-3V 1530320 RADIOLOGY 3000032XR PELVIS 1-2V 234320 RADIOLOGY 3000033XR PELVIS 3V 254320 RADIOLOGY 3000034XR SI JT 1-2V 234320 RADIOLOGY 3000035XR SI JT 3V 254320 RADIOLOGY 3000036XR SACRUM & COCCYX 2V 234320 RADIOLOGY 3000037XR MYELO C-SP 2538320 RADIOLOGY 3000038XR MYELO T-SP 2538320 RADIOLOGY 3000039XR MYELO L-SP 2538320 RADIOLOGY 3000040XR MYELO ENTIRE 2538320 RADIOLOGY 3000042XR CLAVICAL 2V 234320 RADIOLOGY 3000043XR SCAP COMP 254320 RADIOLOGY 3000044XR SHOULDER R 2V 254320 RADIOLOGY 3000045XR ARTHRO SHLD 1493320 RADIOLOGY 3000046XR AC JNT 234320 RADIOLOGY 3000047XR HUMERUS R 2V 254320 RADIOLOGY 3000048XR ELBOW R 2V 234320 RADIOLOGY 3000049XR ELBOW R 3V 234320 RADIOLOGY 3000050XR ARTHRO ELB 983320 RADIOLOGY 3000051XR FOREARM R 2V 234320 RADIOLOGY 3000052XR WRIST R 2V 234320 RADIOLOGY 3000053XR WRIST R 3V 254320 RADIOLOGY 3000054XR HAND R 2V 234320 RADIOLOGY 3000055XR HAND R 3V 254320 RADIOLOGY 3000056XR FINGER R 2-3V 234320 RADIOLOGY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3000057XR HIP RT 1V 234320 RADIOLOGY 3000058XR HIP RT 2V 254320 RADIOLOGY 3000059XR HIP BILAT 2V 354320 RADIOLOGY 3000060XR ARTHRO HIP 1493320 RADIOLOGY 3000061XR FEMUR R 2V 254320 RADIOLOGY 3000062XR KNEE R 1-2V 234320 RADIOLOGY 3000063XR KNEE R 3V 254320 RADIOLOGY 3000064XR KNEE R 4V 354320 RADIOLOGY 3000065XR KNEES BIL STAND 254320 RADIOLOGY 3000066XR KNEE ARTHRO 2993320 RADIOLOGY 3000067XR TIBFIB R 2V 254320 RADIOLOGY 3000068XR ANKLE R 2V 234320 RADIOLOGY 3000069XR ANKLE R 3V 234320 RADIOLOGY 3000070XR FOOT R 2V 234320 RADIOLOGY 3000071XR FOOT R 3V 254320 RADIOLOGY 3000072XR CALC R 2V 234320 RADIOLOGY 3000073XR TOE R 2V 234320 RADIOLOGY 3000074XR ABD 1V 234320 RADIOLOGY 3000075XR ABD 3V 303320 RADIOLOGY 3000076XR ABD 2V 264320 RADIOLOGY 3000077XR ABD ACUTE 396320 RADIOLOGY 3000078XR Ba SWALLOW 477320 RADIOLOGY 3000079XR SBFT 477320 RADIOLOGY 3000080XR NG TUBE 122320 RADIOLOGY 3000081XROR FLUORO- 426320 RADIOLOGY 3000082XROR FLUORO+ 442320 RADIOLOGY 300008372240 MYELO C-SP 490.58320 RADIOLOGY 300008472265 MYELO L-SP 477.38320 RADIOLOGY 3000085XR BONE LENGTH 234320 RADIOLOGY 3000086XR SPINE PUNCT LUMB 1512360 OR SERVICES 3000087INJ.FOR MYELOGRAM 483360 OR SERVICES 3000088XR CHEST 1V 252320 RADIOLOGY 3000089XR SHOULDER R 1V 100320 RADIOLOGY 3000090XR SHOULDER L 1V 100320 RADIOLOGY 3000092XROR SPINE 1V 263320 RADIOLOGY 3000093XROR C-SP 2-3V 303320 RADIOLOGY 3000094XROR T-SP 2V 234320 RADIOLOGY 3000095XROR L-SP 2-3V 303320 RADIOLOGY 3000096XROR T-L SP 2V 234320 RADIOLOGY 3000097XROR SI JT 1-2V 234320 RADIOLOGY 3000098XROR ELBOW L 2V 234320 RADIOLOGY 3000099XROR ELBOW R 2V 234320 RADIOLOGY 3000100XROR SHOULDER L 2V 254320 RADIOLOGY 3000101XROR SHOULDER R 2V 254320 RADIOLOGY 3000102XROR SHOULDER L 1V 100320 RADIOLOGY 3000103XROR SHOULDER R 1V 100320 RADIOLOGY 300010472255 MYELO T-SP 524.99320 RADIOLOGY 300010572270 MYELO ENTIRE-SP 661.6320 RADIOLOGY 300010674020 XR ABD 2V 264320 RADIOLOGY 3000116XR CHEST 3V 292320 RADIOLOGY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3000231XR CHEST 2V 272320 RADIOLOGY 3003002XR CHEST 4V 292320 RADIOLOGY 3003003XR RIB LT 2V 234320 RADIOLOGY 3003004XR RIB LT 3V 303320 RADIOLOGY 3003005XR SCOLI 2-3V 469320 RADIOLOGY 3003006XR SCOLI 4-5V 469320 RADIOLOGY 3003007XR SCOLI 6+V 469320 RADIOLOGY 3003008XR SHOULDER L 2V 254320 RADIOLOGY 3003009XR HUMERUS L 2V 254320 RADIOLOGY 3003010XR ELBOW L 2V 234320 RADIOLOGY 3003011XR ELBOW L 3V 234320 RADIOLOGY 3003012XR FOREARM L 2V 234320 RADIOLOGY 3003013XR WRIST L 2V 234320 RADIOLOGY 3003014XR WRIST L 3V 254320 RADIOLOGY 3003015XR HAND L 2V 234320 RADIOLOGY 3003016XR HAND L 3V 254320 RADIOLOGY 3003017XR FINGER L 2-3V 234320 RADIOLOGY 3003018XR HIP LT 1V 234320 RADIOLOGY 3003019XR HIP LT 2V 254320 RADIOLOGY 3003020XR FEMUR L 2V 254320 RADIOLOGY 3003021XR KNEE L 1-2V 234320 RADIOLOGY 3003022XR KNEE L 3V 254320 RADIOLOGY 3003023XR KNEE L 4V 354320 RADIOLOGY 3003024XR TIBFIB L 2V 254320 RADIOLOGY 3003025XR ANKLE L 2V 234320 RADIOLOGY 3003026XR ANKLE L 3V 234320 RADIOLOGY 3003027XR FOOT L 2V 234320 RADIOLOGY 3003028XR FOOT L 3V 254320 RADIOLOGY 3003029XR CALC L 2V 234320 RADIOLOGY 3003030XR TOE L 2V 234320 RADIOLOGY 3003031XR FACE 1-2V 254320 RADIOLOGY 3100001MRI ORB/NCK WO 1921614 MRI/OTHER 3100002MRI ORB/NCK W 2273614 MRI/OTHER 3100003MRI ORB/NCK W&WO 2779614 MRI/OTHER 3100004MRI BRAIN WO 1921611 MRI - BRAIN 3100005MRI BRAIN W 2273611 MRI - BRAIN 3100006MRI BRAIN W&WO 2784611 MRI - BRAIN 3100007MRI C-SP WO 1921612 MRI - SPINE 3100008MRI C-SP W 2273612 MRI - SPINE 3100009MRI T-SP WO 1921612 MRI - SPINE 3100010MRI T-SP W 2273612 MRI - SPINE 3100011MRI L-SP WO 1921612 MRI - SPINE 3100012MRI L-SP W 2273612 MRI - SPINE 3100013MRI C-SP W&WO 2784612 MRI - SPINE 3100014MRI T-SP W&WO 2784612 MRI - SPINE 3100015MRI L-SP W&WO 2784612 MRI - SPINE 3100016MRI PELVIS WO 1921614 MRI/OTHER 3100017MRI PELVIS W 2273614 MRI/OTHER 3100018MRI PELVIS W&WO 2784614 MRI/OTHER 3100019MRI UP EXT R WO 1921614 MRI/OTHER

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3100020MRI UP EXT R W 2273614 MRI/OTHER 3100021MRI UP EXT R W&WO 2784614 MRI/OTHER 3100022MRI UP JNT R WO 1921614 MRI/OTHER 3100023MRI UP JNT R W 2273614 MRI/OTHER 3100024MRI UP JNT R W&WO 2784614 MRI/OTHER 3100025MRI LOW EXT R WO 1921614 MRI/OTHER 3100026MRI LOW EXT R W 2273614 MRI/OTHER 3100027MRI LOW EXT R W&WO 2784614 MRI/OTHER 3100028MRI LOW JNT R WO 2041614 MRI/OTHER 3100029MRI LOW JNT R W 2273614 MRI/OTHER 3100120MRI LOW EXT L W&WO 2784614 MRI/OTHER 3100121MRI LOW EXT L WO 1921614 MRI/OTHER 3100122MRI LOW EXT L W 2273614 MRI/OTHER 3100123MRI LOW JNT L WO 2041614 MRI/OTHER 3100124MRI LOW JNT L W 2273614 MRI/OTHER 3100125MRI LOW JNT R W&WO 2273614 MRI/OTHER 3100126MRI LOW JNT L W&WO 2273614 MRI/OTHER 3100127MRI UP EXT L W&WO 2784614 MRI/OTHER 3100128MRI UP EXT L W 2273614 MRI/OTHER 3100129MRI UP EXT L WO 1921614 MRI/OTHER 3100130MRI UP JNT L WO 1921614 MRI/OTHER 3100131MRI UP JNT L W 2273614 MRI/OTHER 3100132MRI UP JNT L W&WO 2784614 MRI/OTHER 3100133MRA HEAD 1921611 MRI - BRAIN 3100134MRA HEAD PRO FEE 300611 MRI - BRAIN 3200001CT HEAD WO 1019350 CAT SCAN 3200002CT HEAD W 1397350 CAT SCAN 3200003CT HEAD W&WO 1628350 CAT SCAN 3200004CT ORBIT WO 1019350 CAT SCAN 3200005CT ORBIT W&WO 1628350 CAT SCAN 3200006CT SINUS/FACE WO 1019350 CAT SCAN 3200007CT FACIAL W&WO 1628350 CAT SCAN 3200008CT NECK WO 1019350 CAT SCAN 3200009CT NECK W 1397350 CAT SCAN 3200010CT NECK W&WO 1628350 CAT SCAN 3200011CTA HEAD 1645350 CAT SCAN 3200012CT CHEST WO 1019350 CAT SCAN 3200013CT CHEST W 1397350 CAT SCAN 3200014CT CHEST W&WO 1628350 CAT SCAN 3200015CTA CHEST 1764350 CAT SCAN 3200016CT C-SP WO 1019350 CAT SCAN 3200017CT T-SP WO 1019350 CAT SCAN 3200018CT T-SP W&WO 1628350 CAT SCAN 3200019CT L-SP WO 1200350 CAT SCAN 3200020CT L-SP W&WO 1628350 CAT SCAN 3200021CT PELVIS WO 1019350 CAT SCAN 3200022CT PELVIS W 1397350 CAT SCAN 3200023CT PELVIS W&WO 1671350 CAT SCAN 3200024CT UP EXT R WO 1019350 CAT SCAN 3200025CT LOW EXT R WO 1019350 CAT SCAN

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3200026CT LOW EXT R W 1397350 CAT SCAN 3200027CT LOW EXT R W&WO 1628350 CAT SCAN 3200028CT ABD WO 1019350 CAT SCAN 3200029CT ABD W 1397350 CAT SCAN 3200030CT ABD W&WO 1628350 CAT SCAN 3200031CT ABD/PELV WO 1530350 CAT SCAN 3200032CT ABD/PELV W 2413350 CAT SCAN 3200033CT ABD/PELV W&WO 2413350 CAT SCAN 3200034CT RECON 506350 CAT SCAN 3200035CT GUIDED BX 1394350 CAT SCAN 3200037CT L-SP W 1245350 CAT SCAN 3200038CT T-SP W 1245350 CAT SCAN 3200039CT C-SP W 1245350 CAT SCAN 3200041CT GUIDED 1394350 CAT SCAN 3200086CT C-SP BEALL WO 1019350 CAT SCAN 3200087CT T-SP BEALL WO 1019350 CAT SCAN 3200089CT L-SP BEALL WO 1200350 CAT SCAN 3200100CT ORBIT W 1019350 CAT SCAN 3200101CT SINUS/FACE W 1019350 CAT SCAN 3200102CT C-SP W&WO 1245350 CAT SCAN 3200103CT UP EXT L WO 1019350 CAT SCAN 3200104CT UP EXT R W 1019350 CAT SCAN 3200105CT UP EXT L W 1019350 CAT SCAN 3200106CT UP EXT R W&WO 1019350 CAT SCAN 3200107CT UP EXT L W&WO 1019350 CAT SCAN 3200108CT LOW EXT L WO 1019350 CAT SCAN 3200109CT LOW EXT L W 1397350 CAT SCAN 3200110CT LOW EXT L W&WO 1628350 CAT SCAN 3300004US VEN BI LOW/UP 1547483 ECHOCARDIOLOGY 3300005US VEN RT LOW/UP 738483 ECHOCARDIOLOGY 3300008US VEN LT LOW/UP 738483 ECHOCARDIOLOGY 3800003Propranolol (Inderal) 1mg/ml Vial 40636 DRUGS/DETAIL CODE 3800006Levothyroxine (Synthroid) 125mcg Tab 4250 PHARMACY 3800007Melatonin 5 mg Tablet 4250 PHARMACY 3800008Losartan/HCTZ (Hyzaar 100/25) 13.75250 PHARMACY 3800009Losartan/HCTZ (Hyzaar 50/12.5) 10250 PHARMACY 3800011Lisinopril/Hydrochlorthiazide (20/12.5) 5250 PHARMACY 3800012Lisinopril 40mg Tab 6.3250 PHARMACY 3800013Vilazodone (Viibryd) 20mg Tab 18250 PHARMACY 3800014Lisinopril/Hydrochlorthiazide (10/12.5) 4.5250 PHARMACY 3800015Levothyroxine (Synthroid) 112mcg Tab 4250 PHARMACY 3800016Donnatal/Lidocaine/Maalox (GI Cocktail) 40250 PHARMACY 3800017Fenofibrate (Tricor) 48mg Tab 7.75250 PHARMACY 3800018Dabigatran (Pradaxa) 75mg Tab 19250 PHARMACY 3800019Acetaminophen/Codeine(Tylenol #3) Tab 6250 PHARMACY 3800021Fenofibrate (Tricor) 145mg Tab 20.6250 PHARMACY 3800022Naproxen (Aleve) 275mg Tab 4250 PHARMACY 3800023Buprenorphine (Butrans Patch) 5mcg 176250 PHARMACY 3800024Insulin glulisine (Apidra) 250250 PHARMACY 3800025Eszopiclone (Lunesta) 3mg Tab 39.5250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800027Calcium Polycarbophil (Fibercon) 625mg 4250 PHARMACY 3800030Ketoconazole (Nizoral) Cream 110250 PHARMACY 3800031Glimepiride (Amaryl) 4mg Tab 4.9250 PHARMACY 3800032Fexofenadine (Allegra) 180mg Tab 4.5250 PHARMACY 3800033Propafenone (Rythmol) 150mg Tab 12250 PHARMACY 3800035Sodium Chloride (NACL 10%) Syringe 25250 PHARMACY 3800037Verapamil CR 120mg Tab 10250 PHARMACY 3800039Duloxetine (Cymbalta) 60mg Cap 35250 PHARMACY 3800040Quinapril (Accupril) 10mg Cap 4.9250 PHARMACY 3800041Liothyronine (Cytomel) 5mcg Tab 4250 PHARMACY 3800042Magnesium Sulfate 1gm/2ml 10636 DRUGS/DETAIL CODE 3800045Cholecalciferol (Vitamin D-3) 2000units 4250 PHARMACY 3800047Oxybutynin (Ditropan XL) 5mg Tab 13250 PHARMACY 3800048Latanoprost (Xalatan 0.005% Eye Drops) 25250 PHARMACY 3800051Vitamin B Complex Cap 4250 PHARMACY 3800053Aripiprazole (Abilify) 5mg Tab 105250 PHARMACY 3800056Amlodipine/Benazepril (Lotrel 5/20) Tab 11.5250 PHARMACY 3800058Progesterone (Prometrium) 100mg Cap 5250 PHARMACY 3800061Hyaluronidase 150 units/ml 172636 DRUGS/DETAIL CODE 3800064Budesonide/Formoterol(Symbicort Inhaler) 510250 PHARMACY 3800066Ammonia (Ammonia Inh) Inhaler 4250 PHARMACY 3800067Silver Nitrate Sticks 4250 PHARMACY 3800069Simvastatin (Zocor) 40mg Tab 20250 PHARMACY 3800070Duloxetine (Cymbalta) 20mg Tab 15250 PHARMACY 3800071Cholecalciferol (Vitamin D) 50000units 5.75250 PHARMACY 3800077Allopurinol (Zyloprim) 100mg Tab 4250 PHARMACY 3800078Raltegravir (Isentress) 400mg Tab 170250 PHARMACY 3800079Emtricitabine/Tenofovir(Truvada 200/300) 200250 PHARMACY 3800080Dicyclomine (Bentyl) 10mg Cap 4250 PHARMACY 3800081Levothyroxine (Synthroid) 88mcg Tab 4250 PHARMACY 3800083Rivaroxaban (Xarelto) 15mg Tab 42.5250 PHARMACY 3800084Nitroglycerin 100mg/250ml IVPB Premix 44250 PHARMACY 3800085Liraglutide (Victoza) 6mg/ml 700250 PHARMACY 3800086Hepatitis B Vaccine (Engerix-B ) 140250 PHARMACY 3800087Thiamine 100mg Tab 4250 PHARMACY 3800088Lithium 150mg 4250 PHARMACY 3800089Cholecalciferol (Vitamin D-3) 1000units 4250 PHARMACY 3800090Clonidine 100mcg/ml 79636 DRUGS/DETAIL CODE 3800091Hydrochlorothiazide 12.5 mg 4250 PHARMACY 3800092Magnesium Oxide 400mg 4250 PHARMACY 3800093Probiotic Cap 4250 PHARMACY 3800096Clinimix 5%-20% (TPN) Premix 1000ML IV 1000250 PHARMACY 3800097Hydralazine (Apresoline) 25mg Tab 4250 PHARMACY 3800098Risperidone (Risperdal) 1mg Tab 181.5250 PHARMACY 3800100Hydroxychloroquine (Plaquenil) 200mg Tab 4250 PHARMACY 3800102Tetracaine 0.5% Eye Dropper 40250 PHARMACY 3800103Isometheptene/APAP/Caffeine (Prodrin) 20250 PHARMACY 3800105Insulin lispro (Humalog(Novolog) 75/25) 150250 PHARMACY 3800106Charcoal (Insta-Char Liquid) 25gm 50250 PHARMACY 3800109Hydromorphone (Exalgo) 8mg Tab 44250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800110Amitriptyline (Elavil) 100mg Tab 4250 PHARMACY 3800111Pramipexole (Mirapex) 0.5mg Tab 4250 PHARMACY 3800112Metformin (Glucophage) 850mg Tab 4250 PHARMACY 3800116Pravastatin (Pravachol) 20mg Tab 13250 PHARMACY 3800119Cefazolin (Ancef) 10gm Vial 45250 PHARMACY 3800120Hydromorphone (Dilaudid) 10mg/ml Vial 12250 PHARMACY 3800122Nitroprusside (Nitropress) 50mg Vial 40250 PHARMACY 3800123Sodium Bicarbonate 50ml Syringe 21250 PHARMACY 3800125Meropenem (Merrem) 1gm Vial 54636 DRUGS/DETAIL CODE 3800126Cisatracurium (Nimbex) 2mg/ml (5ml) 100250 PHARMACY 3800127Normal Saline KCL 20meq / 1000ml 100250 PHARMACY 3800128Fluticasone/Salmeterol (Advair 500/50) 760250 PHARMACY 3800129Potassium Chloride 20meq Vial 20636 DRUGS/DETAIL CODE 3800130Gabapentin (Neurontin ) 600mg Tab 10250 PHARMACY 3800131Nortriptyline (Pamelor) 10mg Cap 4250 PHARMACY 3800133Cholestyramine (Questran) 4gm Powder 25250 PHARMACY 3800137Ibuprofen (Motrin) 800mg Tab 4250 PHARMACY 3800138Acetazolamide (Diamox) 500mg Cap 7250 PHARMACY 3800140Losartan (Cozaar) 50mg Tab 9250 PHARMACY 3800147Promethazine (Phenergan) 25mg Suppo 20250 PHARMACY 3800151Folate (Folic Acid) 1mg Tab 4250 PHARMACY 3800154Hyaluronate (Hyalgan) 20mg/2ml 44636 DRUGS/DETAIL CODE 3800155Potassium (K-Dur) 10meq Tab 4250 PHARMACY 3800156Insulin Glargine (Lantus) 400250 PHARMACY 3800157Epinephrine 1mg Amp 17636 DRUGS/DETAIL CODE 3800158Epinephrine 30ml Vial 975250 PHARMACY 3800159Ketorolac (Toradol) 60mg/ml 30636 DRUGS/DETAIL CODE 3800161Oxycodone ER (Oxycontin) 10mg Tab 10250 PHARMACY 3800162Hydroxyzine (Vistaril) 25mg/ml Vial 8636 DRUGS/DETAIL CODE 3800163Vancomyin 1gm AddVantage Vial 100258 IV SOLUTIONS 3800164Nicotine 21mg Patch 16250 PHARMACY 3800165Dexamethasone (Decadron) 10mg Vial 17636 DRUGS/DETAIL CODE 3800166MOM (Milk of Magnesia) 30ml Liquid 4250 PHARMACY 3800167Methylprednisolone (Depo-Medrol) 80mg 65636 DRUGS/DETAIL CODE 3800171Nafcillin 2gm Vial 25250 PHARMACY 3800173Sodium Chloride 0.9% 1000ml 100258 IV SOLUTIONS 3800176Sodium Chloride 1gm Tab 4250 PHARMACY 3800177Fluconazole (Diflucan) 400mg/200ml IVPB 675258 IV SOLUTIONS 3800179Cefazolin (Ancef) 1gm Vial 35636 DRUGS/DETAIL CODE 3800181Guaifenesin/Dextromethorp(Robitussin DM) 6250 PHARMACY 3800183Chloroprocaine (Nesacaine 2%) 20ml Vial 110636 DRUGS/DETAIL CODE 3800185Neostigmine 1:1000 Vial 130250 PHARMACY 3800187Methocarbamol (Robaxin) 750mg/7.5ml Vial 100258 IV SOLUTIONS 3800190Eszopiclone (Lunesta) 1mg Tab 16250 PHARMACY 3800191Hetastarch (Hextend 6%) 500ml 155258 IV SOLUTIONS 3800193Ephedrine 50mg Vial 140250 PHARMACY 3800194Dextrose 5% -1/2 NS/KCL 20meq 1000ml 100258 IV SOLUTIONS 3800195Lidocaine 4% 35250 PHARMACY 3800196Phenylephrine (Neosynephrine) 10mg Vial 13636 DRUGS/DETAIL CODE 3800197Triamcinolone (Kenalog) 40mg/ml Vial 50636 DRUGS/DETAIL CODE

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800198Lidocaine (LTA Kit) 68250 PHARMACY 3800200Propofol (Diprivan) 10mg/ml 20ml Vial 100636 DRUGS/DETAIL CODE 3800201Metoclopramide (Reglan) 10mg/2ml Vial 12636 DRUGS/DETAIL CODE 3800202Oxycodone/APAP (Percocet 10/325) Tab 15250 PHARMACY 3800203Gabapentin (Neurontin) 300mg Cap 6259 DRUGS/OTHER 3800205Carisoprodol (Soma) 350mg Tab 16250 PHARMACY 3800206Carmex ointment 5250 PHARMACY 3800207Morphine 5mg/ml Vial 10250 PHARMACY 3800208Aluminium/Magnesium(Maalox Susp) 10250 PHARMACY 3800209Famotidine (Pepcid) 20mg/50ml IVPB Premi 26250 PHARMACY 3800211Fentanyl 250mcg/5ml Vial 30636 DRUGS/DETAIL CODE 3800212Morphine PCA 150MG/30ML (5mg/1ml) 70636 DRUGS/DETAIL CODE 3800213Furosemide (Lasix) 10mg/ml (4ml) Vial 10636 DRUGS/DETAIL CODE 3800214Ropivacaine (Naropin 0.5%) 20ml Vial 65250 PHARMACY 3800215Duloxetine (Cymbalta) 30mg Cap 16250 PHARMACY 3800222Phenol 8% 60250 PHARMACY 3800223Methocarbamol (Robaxin) 750mg Tab 5250 PHARMACY 3800224Ketorolac (Toradol) 30mg/ml 15636 DRUGS/DETAIL CODE 3800225Midazolam (Versed) 1mg/ml (5ml) Vial 55636 DRUGS/DETAIL CODE 3800226Iopamidol (Isovue-M 200 41%) 10ml 62255 DRUGS/INCIDENT RAD 3800227Clindamycin (Cleocin) 600mg/50ml IVPB Pr 90258 IV SOLUTIONS 3800228Metoclopramide (Reglan) 10mg Tab 8259 DRUGS/OTHER 3800229Oxycodone ER (Oxycontin) 20mg Tab 21250 PHARMACY 3800230Fentanyl 100mcg/2ml Vial 20636 DRUGS/DETAIL CODE 3800231Tizanidine (Zanaflex) 4mg Tab 8250 PHARMACY 3800232Lidocaine 1% 30ml 50636 DRUGS/DETAIL CODE 3800233Morphine 8mg/ml Vial 10250 PHARMACY 3800234Sodium Chloride 0.9% 20ml 7258 IV SOLUTIONS 3800235Sodium Chloride 0.9% 50ml 6258 IV SOLUTIONS 3800236Chloraseptic Spray 8250 PHARMACY 3800237Iopamidol (Isovue-M 200 41%) 20ml 75255 DRUGS/INCIDENT RAD 3800239Clindamycin (Cleocin) 900mg/50ml IVPB Pr 95258 IV SOLUTIONS 3800240Buffered Lidocaine 1%/1ml 15636 DRUGS/DETAIL CODE 3800241Zolpidem (Ambien) 10mg Tab 15250 PHARMACY 3800243Cephalexin (Keflex) 500mg Cap 13250 PHARMACY 3800244Alprazolam (Xanax) 0.5mg Tab 10250 PHARMACY 3800245Morphine 10mg/ml Vial 10636 DRUGS/DETAIL CODE 3800246Omeprazole (Prilosec) 20mg Cap 20250 PHARMACY 3800247Remifentanil (Ultiva) 25mcg/ml Syringe 25250 PHARMACY 3800248Atropine Syringe 1 mg/10ml 13636 DRUGS/DETAIL CODE 3800249Meperidine (Demerol) 25mg Vial 6636 DRUGS/DETAIL CODE 3800250Temazepam (Restoril) 15mg Cap 5250 PHARMACY 3800251Bacitracin Powder 50000 units 90250 PHARMACY 3800252Bupivacine (Marcaine 0.5%) 10ml Vial 45250 PHARMACY 3800253Meperidine (Demerol) 50mg Vial 10636 DRUGS/DETAIL CODE 3800255Lidocaine 2% 5ml 10636 DRUGS/DETAIL CODE 3800256Morphine (Duramorph) 10mg/10ml Vial 40636 DRUGS/DETAIL CODE 3800257Scopalamine (Transderm-Scop) 1.5mg Patch 85250 PHARMACY 3800258Esomeprazole (Nexium) 20mg Cap 15250 PHARMACY 3800259Hydromorphone (Dilaudid) 2mg Tab 6250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800260Bupivacaine (Marcaine 0.25%) 10ml Vial 20250 PHARMACY 3800261Meperidine (Demerol) 100mg Vial 10636 DRUGS/DETAIL CODE 3800262Methylprednisolone (Depo-Medrol) 40mg 40636 DRUGS/DETAIL CODE 3800263Calcium Carbonate (Tums) 500mg Tab 4250 PHARMACY 3800264Heparin (Artline 2 units/ml) 100258 IV SOLUTIONS 3800265Gelfoam 12-7 135250 PHARMACY 3800266Lidocaine (Lidoderm) Patch 30250 PHARMACY 3800267Heparin (Cell Saver) 500ml 100636 DRUGS/DETAIL CODE 3800268Methadone 10mg Tab 6250 PHARMACY 3800270Midazolam (Versed) 1mg/ml (2ml) Vial 30636 DRUGS/DETAIL CODE 3800271Normal Saline Flush 3ml 10250 PHARMACY 3800272APAP/Butalbital/Caffeine(Fioricet) Tab 6250 PHARMACY 3800273Insulin Regular (Humulin R) 30250 PHARMACY 3800274Thrombin 5000units 360250 PHARMACY 3800275Dextrose 5% 1/2 Normal Saline 1000ml 100258 IV SOLUTIONS 3800276Bupivacaine/EPI(Marcaine/EPI 0.25%)30ml 40250 PHARMACY 3800277Gelfoam Powder (SurgiFoam) 365250 PHARMACY 3800278Sertraline (Zoloft) 50mg Tab 12250 PHARMACY 3800279Labetalol 5mg/ml Vial 50250 PHARMACY 3800280Thrombin 20000 units Spray 1486250 PHARMACY 3800281Donepezil (Aricept) 10mg Tab 10250 PHARMACY 3800282Cepacol tab 4250 PHARMACY 3800283Diphenhydramine (Benadryl) 50mg/ml 8636 DRUGS/DETAIL CODE 3800284Flu Vaccine (Influenza Vaccine) Vial 44250 PHARMACY 3800285Lansoprazole (Prevacid) 15mg Cap 10250 PHARMACY 3800286Acetaminophen (Tylenol) 325mg Tab 4250 PHARMACY 3800287Hydrocodone/Acetaminophen(Norco 7.5/325) 8250 PHARMACY 3800288Methylprednisolone (Medrol Dospak) 4mg 100636 DRUGS/DETAIL CODE 3800289Bethanechol (Urecholine) 25mg Tab 8250 PHARMACY 3800290Lisinopril 10mg Tab 6250 PHARMACY 3800291Ciprofloxacin (Cipro) 500mg Tab 25250 PHARMACY 3800292Magnesium Citrate 10250 PHARMACY 3800294Hydrochlorothiazide 25mg tab 4250 PHARMACY 3800295Oxycodone IR (Oxy-IR) 5mg Tab 10250 PHARMACY 3800296Zolpidem (Ambien) 5mg Tab 20250 PHARMACY 3800297Insulin Lispro (Humalog) 60250 PHARMACY 3800298Dexamethasone (Decadron) 4mg/1ml 10636 DRUGS/DETAIL CODE 3800299Diphenhydramine (Benadryl) 50mg Cap 4250 PHARMACY 3800300Hydrocodone/Acetaminophen(Norco 10/325) 8259 DRUGS/OTHER 3800301Pregabalin (Lyrica) 25mg Cap 10250 PHARMACY 3800302Dextrose 5% Normal Saline 1000ml 100258 IV SOLUTIONS 3800303Dexamethasone (Decadron) 4mg Tab 10250 PHARMACY 3800306Levalbuterol (Xopenex) 1.25mg/3ml 13250 PHARMACY 3800307Mupirocin (Bactroban) 22gm Oint 100250 PHARMACY 3800308Normal Saline Inhalation 3ml 4250 PHARMACY 3800309Acetaminophen (Ofirmev) 1000mg/100ml 140636 DRUGS/DETAIL CODE 3800310Cyclobenzaprine (Flexeril) 10mg Tab 8250 PHARMACY 3800311Tramadol (Ultram) 50mg Tab 10250 PHARMACY 3800312Sulfamethoxaz/Trimethop (Bactrim DS) Tab 8250 PHARMACY 3800314Oxycodone IR (Oxy-IR) 20mg Tab 30250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800315Diphenhydramine (Benadryl) 25mg Cap 4250 PHARMACY 3800316Heparin 100units/ml Vial 10250 PHARMACY 3800317Diazepam (Valium) 5mg Tab 8636 DRUGS/DETAIL CODE 3800318Albuterol Nebulizer 2.5 mg/3ml 40250 PHARMACY 3800319Docusate (Colace) 100mg Cap 8250 PHARMACY 3800320Ondansetron (Zofran) 4mg/2ml Vial 75636 DRUGS/DETAIL CODE 3800321Ranitidine (Zantac) 150mg Tab 16250 PHARMACY 3800322Polyethylene Glycol (Miralax) 17gm Pwd 10250 PHARMACY 3800323Famotidine (Pepcid) 20mg Tab 8259 DRUGS/OTHER 3800324Saline Flush 10ml 10272 STERILE SUPPLY 3800325Senna/Docusate (Senokot-S) Tab 8259 DRUGS/OTHER 3800326Oxycodone IR (Oxy-IR) 10mg Tab 15250 PHARMACY 3800327Promethazine (Phenergan) 25mg Vial 15636 DRUGS/DETAIL CODE 3800328Hydromorphone (Dilaudid) 2mg/ml Vial 10636 DRUGS/DETAIL CODE 3800331Mepivacaine (Carbocaine) 30ml Vial 44250 PHARMACY 3800334Olmesartan (Benicar) 20mg Tab 10250 PHARMACY 3800336Dextrose 5% Water 250ml 100258 IV SOLUTIONS 3800338Phenazopyridine (Pyridium) 100mg Tab 7250 PHARMACY 3800339Saline (Ocean Nasal) Spray 11250 PHARMACY 3800340Melatonin 3mg 1 tab 10250 PHARMACY 3800341Loperamide (Imodium) 2mg Tab 4250 PHARMACY 3800342Omega 3 (Fish Oil) 1000mg Cap 4250 PHARMACY 3800343Triple Antibiotic Ointment 4250 PHARMACY 3800344Meclizine (Antivert) 25mg Tab 4250 PHARMACY 3800346Paroxetine (Paxil) 20mg Tab 13250 PHARMACY 3800348Betamethasone (Celestone) 6mg/ml(5ml) 150636 DRUGS/DETAIL CODE 3800349Finasteride (Proscar) 5mg Tab 13250 PHARMACY 3800350Calcium Gluconate 1 gm vial 9636 DRUGS/DETAIL CODE 3800351Ferrous Gluconate (Feragon) 324mg Tab 4250 PHARMACY 3800352IRBESARTAN (Avapro) 150mg Tab 13250 PHARMACY 3800356Buspirone (Buspar) 10mg Tab 4250 PHARMACY 3800357Triamterene/HCTZ (Maxzide 75/50) Tab 4250 PHARMACY 3800358Amoxicillin 500mg Cap 4250 PHARMACY 3800359Gemfibrozil (Lopid) 600mg Tab 9250 PHARMACY 3800361Doxapram (Dopram) 20mg/ml (20ml) 390250 PHARMACY 3800363Ropinirole (Requip) 1mg Tab 4250 PHARMACY 3800364Lactated Ringers 1000ml 100258 IV SOLUTIONS 3800366Diphenoxylate/Atropine(Lomotil)2.5mg Tab 6250 PHARMACY 3800368Epinephrine 1mg Syringe 22250 PHARMACY 3800369Vancomycin in NS IVPB: 1.5gm / 500ml 150250 PHARMACY 3800370Verapamil 5mg/2ml 10250 PHARMACY 3800372Citalopram (Celexa) 40mg Tab 11250 PHARMACY 3800373Chlorodiazepoxide (Librium) 25mg Tab 7250 PHARMACY 3800374Alprazolam ER (Xanax ER) 1mg Tab 12250 PHARMACY 3800376Phytonadione (Vitamin K) 10mg Amp 160636 DRUGS/DETAIL CODE 3800378Dicloxacillin (Dynapen) 250mg Cap 4250 PHARMACY 3800379Dronabinol (Marinol) 2.5mg Tab 24250 PHARMACY 3800381Loratadine (Claritin) 10mg Tab 4250 PHARMACY 3800384Aspirin/Caffeine/APAP(Excedrin Migraine) 8250 PHARMACY 3800386Chlorpromazine (Thorazine) 25mg/ml 19636 DRUGS/DETAIL CODE

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800387Rizatriptan (Maxalt) 10mg Tab 76250 PHARMACY 3800388Ipratropium/Albuterol (Combivent) inhale 260250 PHARMACY 3800390Bupivacaine (Marcaine/EPI 0.25%) 10ml 40250 PHARMACY 3800391Methylene Blue 10ml Vial 32250 PHARMACY 3800392Carbamazepine (Tegretol) 200mg Tab 4250 PHARMACY 3800394Flumazenil (Romazicon) 0.1mg/ml 88250 PHARMACY 3800395Cefuroxime (Ceftin) 250mg Tab 23250 PHARMACY 3800397Diltiazem (Cardizem) 120mg Cap 8250 PHARMACY 3800398Oxycodone/APAP (Percocet 7.5/325) Tab 12250 PHARMACY 3800399Clonidine (Catapres) 0.1mg Tab 4636 DRUGS/DETAIL CODE 3800400Amiodarone (Cordarone) 200mg Tab 30250 PHARMACY 3800404Fluticasone/Salmeterol (Advair 250/50) 550250 PHARMACY 3800406Nitrofurantoin (Macrobid) 100mg Cap 17250 PHARMACY 3800407Furosemide (Lasix) 40mg Tab 4250 PHARMACY 3800408Methylnaltrexone (Relistor) 12mg 415250 PHARMACY 3800409Lidocaine 250ml IVPB Premix 66258 IV SOLUTIONS 3800411Clindamycin (Cleocin) 150mg Cap 12250 PHARMACY 3800413Acetazolamide (Diamox) 250mg Cap 6250 PHARMACY 3800416Iopamidol (Isovue-M 300 61%) 56255 DRUGS/INCIDENT RAD 3800417Bicitra 30ml 4250 PHARMACY 3800418Gadodiamide (Omniscan) (20ml) Vial 500250 PHARMACY 3800420Insulin detemir (Levemir) 300250 PHARMACY 3800422Heparin 1000units Vial 5636 DRUGS/DETAIL CODE 3800424Lidocaine Inhalation Kit 16250 PHARMACY 3800426Artificial Tears 100 Drops 18250 PHARMACY 3800429Ondansetron (Zofran) 4mg Tab 85636 DRUGS/DETAIL CODE 3800431Nitroglycerin 400mcg Spray 100250 PHARMACY 3800432Eletriptan (Relpax) 40mg Tab 95250 PHARMACY 3800437Benazepril (Lotensin) 10mg Tab 6250 PHARMACY 3800438Glyburide (Micronase ) 5mg Tab 4250 PHARMACY 3800440Caffeine 500mg Vial 93258 IV SOLUTIONS 3800441Tapentadol (Nucynta) 50mg Tab 9250 PHARMACY 3800442Levothyroxine (Synthroid) 25mcg Tab 4250 PHARMACY 3800444Ascorbic Acid (Vitamin C) 500mg Tab 4250 PHARMACY 3800445Desmopressin (DDAVP Vial) 4mcg/1ml 60636 DRUGS/DETAIL CODE 3800446Cholecalciferol (Vitamin D-3) 400units 4250 PHARMACY 3800448Vancomycin 1gm Vial 90636 DRUGS/DETAIL CODE 3800449Sumatriptan (Imitrex) 50mg Tab 72250 PHARMACY 3800452Psyllium (Metamucil) Powder 4250 PHARMACY 3800453Calcium Chloride Syringe 1gm/10ml 7250 PHARMACY 3800456Lidocaine 2% 50ml 20250 PHARMACY 3800458Orphenadrine (Norflex) 30mg/ml 2ml Vial 90250 PHARMACY 3800460Dopamine 400mg/250ml IVPB Premix 82636 DRUGS/DETAIL CODE 3800461Azithromycin (Zithromycin) 250mg Tab 200250 PHARMACY 3800463Zolpidem (Ambien CR) 12.5mg Tab 18250 PHARMACY 3800464Doxycyline (Vibramycin) 50mg Cap 5250 PHARMACY 3800468Quetiapine (Seroquel) 100mg Tab 10250 PHARMACY 3800469Amoxicillin/Clavulanic Acid 875mg Tab 12250 PHARMACY 3800471Dextrose 5% Lactated Ringers 1000ml 100258 IV SOLUTIONS 3800472Solifenacin (Vesicare) 5mg Tab 25250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800473Morphine ER 20mg Tab 12250 PHARMACY 3800476TiotropiumOpth (Spiriva) 18mcg Inhaler 228250 PHARMACY 3800477Diltiazem (Cardizem) 5mg/ml (5ml) 20250 PHARMACY 3800481Tobramyci/Dexamethas (Tobradex Eye) Oint 450250 PHARMACY 3800484Metoprolol-ER (Toprol XL) 50mg Tab 4250 PHARMACY 3800486Insulin aspart (Novolog) 150250 PHARMACY 3800487Mycostatin (Nystatin) 100000units Powder 100250 PHARMACY 3800488Promethazine (Phenergan) 25mg Gel 10250 PHARMACY 3800489Butt Paste 120 gm 20250 PHARMACY 3800490Guaifenesin (Mucinex) 600mg Tab 4250 PHARMACY 3800491Levofloxacin (Levaquin) 750mg/150ml IVPB 235636 DRUGS/DETAIL CODE 3800493Vasopressin 20units/ml 25250 PHARMACY 3800494Hydrocortisone (Solu-Cortef) 100mg/2ml 10636 DRUGS/DETAIL CODE 3800495Alfuzosin (Uroxatral) 10mg Tab 19250 PHARMACY 3800497Rocuronium (Zemuron) 10mg/ml Vial 130250 PHARMACY 3800499Fentanyl (Duragesic) 100mcg Patch 265250 PHARMACY 3800500Methocarbamol (Robaxin) 500mg Tab 4250 PHARMACY 3800501Heparin 10,000units Vial 8636 DRUGS/DETAIL CODE 3800502Protamine 50mg Vial 6636 DRUGS/DETAIL CODE 3800503Carvediol (Coreg) 12.5mg Tab 7250 PHARMACY 3800504Morphine ER 50mg Tab 24250 PHARMACY 3800505Fentanyl (Duragesic) 25mcg Patch 71250 PHARMACY 3800510Amlodipine (Norvasc) 5mg Tab 10250 PHARMACY 3800511Heparin (Hep Lock) 10units/ml Vial 6250 PHARMACY 3800512Ketamine 50mg/ml 65250 PHARMACY 3800513Glucose 4 gm tab 4250 PHARMACY 3800514Promethazine (Phenergan) 50mg Vial 17636 DRUGS/DETAIL CODE 3800515Morphine ER 100mg Tab 21250 PHARMACY 3800517Nabumetone (Relafen) 750mg Tab 5250 PHARMACY 3800518Amphetamine (Adderall) 10mg Tab 8250 PHARMACY 3800521Enoxaparin (Lovenox) 40mg Syringe 14.25636 DRUGS/DETAIL CODE 3800522Morphine ER 15mg Tab 6250 PHARMACY 3800523Papavarine 30mg Vial 15636 DRUGS/DETAIL CODE 3800525Levofloxacin (Levaquin) 500mg IVPB Premi 200258 IV SOLUTIONS 3800526Diphenhydramine (Benadryl Cream 2%) 22250 PHARMACY 3800530Cetirizine (Zyrtec) 10mg Tab 4250 PHARMACY 3800532Levothyroxine (Synthroid) 100mcg Tab 4250 PHARMACY 3800533Pantoprazole (Protonix) 40mg Tab 20250 PHARMACY 3800534Escitalopram (Lexapro) 10mg Tab 10250 PHARMACY 3800535Bupropion (Wellbutrin) 75mg Tab 5250 PHARMACY 3800537Cefazolin (Ancef) 1gm AddVantage Vial 140258 IV SOLUTIONS 3800541Chlorpromazine (Thorazine) 25mg Tab 4250 PHARMACY 3800542Rifampin 300mg Cap 8250 PHARMACY 3800543Bethanechol (Urecholine) 10mg Tab 4636 DRUGS/DETAIL CODE 3800544Oxycodone/APAP (Percocet 5/325) Tab 7250 PHARMACY 3800545Naloxone (Narcan) 0.4mg/ml Vial 25636 DRUGS/DETAIL CODE 3800546Montelukast (Singulair) 10mg Tab 15250 PHARMACY 3800547Metformin (Glucophage) 500mg Tab 4250 PHARMACY 3800553Metoprolol-IR (Lopressor) 50mg Tab 6250 PHARMACY 3800554Mirabegron (Myrbetriq) 25mg Tab 45250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800555Glycopyrrolate (Robinul) 0.2mg/ml 62.5250 PHARMACY 3800556Lidocaine/EPI 1% 20250 PHARMACY 3800560Pneumococcal Vaccine (Pneumovax) Vial 146250 PHARMACY 3800561Remifentanil (Ultiva) 2mg/ml Syringe 60250 PHARMACY 3800562Fluconazole (Diflucan) 100mg Tab 36250 PHARMACY 3800563Lidocaine 1% 50ml 35250 PHARMACY 3800564Thrombin 20000 Units 1415250 PHARMACY 3800565Levofloxacin (Levaquin) 500mg Tab 50636 DRUGS/DETAIL CODE 3800566Atropine 1 mg/1 ml 5636 DRUGS/DETAIL CODE 3800567Hydralazine (Apresoline) 20mg/ml Vial 75636 DRUGS/DETAIL CODE 3800570Acetaminophen (Tylenol) 500mg Tab 4250 PHARMACY 3800571Glipizide (Glucotrol) 5mg Tab 4250 PHARMACY 3800574Fleet Enema 120ml 10250 PHARMACY 3800575Enoxaparin (Lovenox) 30mg Syringe 92636 DRUGS/DETAIL CODE 3800576Amitriptyline (Elavil) 25mg Tab 4250 PHARMACY 3800577Esmolol (Brevibloc) 10mg/ml Vial 95250 PHARMACY 3800578Hydrocortisone (Cortef) 10mg Tab 4250 PHARMACY 3800579Warfarin (Coumadin) 5mg Tab 4250 PHARMACY 3800580Dextrose 5% Water 1000ml 100258 IV SOLUTIONS 3800581Topiramate (Topamax) 25mg Tab 10250 PHARMACY 3800583Bupropion (Wellbutrin XL) 150mg Tab 9250 PHARMACY 3800584Nebivolol (Bystolic) 5mg Tab 8250 PHARMACY 3800586Oxycodone IR (Oxy-IR) 30mg Tab 10250 PHARMACY 3800587Lorazepam (Ativan) 2mg/ml Vial 35636 DRUGS/DETAIL CODE 3800591Metaxalone (Skelaxin) 800mg Tab 13250 PHARMACY 3800592Meperidine PCA 300MG/30ML (10mg/1ml) 50636 DRUGS/DETAIL CODE 3800593Bupivacaine/EPI(Marcaine/EPI 0.5%)30ml 40250 PHARMACY 3800594Rosuvastatin (Crestor) 40mg Tab 14250 PHARMACY 3800595Clindamycin (Cleocin) 900mg/6ml Vial 83250 PHARMACY 3800596Promethazine (Phenergan) 25mg Tab 6250 PHARMACY 3800598Morphine IR 15mg tab 4250 PHARMACY 3800601Cefadroxil (Duricef) 500mg Cap 30250 PHARMACY 3800602Sodium Chloride 0.9% 250ml 44258 IV SOLUTIONS 3800604Simethicone (Gas-X) 80mg Tab 4250 PHARMACY 38006050.45% Normal Saline 1000ml 100258 IV SOLUTIONS 3800606Vecuronium (Norcuron) 10mg Vial 85250 PHARMACY 3800608Albuterol (Proair) Inhaler 190250 PHARMACY 3800609Propofol (Diprivan) 10mg/ml 100ml Vial 150636 DRUGS/DETAIL CODE 3800611Fentanyl (Duragesic ) 75mcg Patch 160250 PHARMACY 3800613Morphine ER 30mg Tab 10250 PHARMACY 3800614Pregabalin (Lyrica) 100mg Cap 25636 DRUGS/DETAIL CODE 3800615Clonazepam (Klonopin) 0.5mg Tab 6250 PHARMACY 3800616Oxycodone ER (Oxycontin) 80mg Tab 50250 PHARMACY 3800618Oxymethazoline (Afrin Nasal 0.05%) Spray 21250 PHARMACY 3800619Gentamicin (Garamycin) 10mg/ml (2ml) 10636 DRUGS/DETAIL CODE 3800621Chlorzoxazone (Parafone Forte) 500mg 7250 PHARMACY 3800622Enalapril (Vasotec) 1.25mg/ml 135250 PHARMACY 3800623Bacitracin Oint 30 gm 20250 PHARMACY 3800626Tamsulosin (Flomax) 0.4mg Cap 12250 PHARMACY 3800628Lidocaine 0.5%/EPI 20250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800629Aspirin Chewable 81mg Tab 4250 PHARMACY 3800630Propofol (Diprivan) 10mg/ml 50ml Vial 200636 DRUGS/DETAIL CODE 3800631Gabapentin (Neurontin) 400mg Cap 27250 PHARMACY 3800632Fluticasone (Flonase Nasal) 50mcg Spray 310250 PHARMACY 3800633Sodium Chloride 0.9% 100ml 25258 IV SOLUTIONS 3800634Lorazepam (Ativan) 1mg Tab 6250 PHARMACY 3800635Trazodone (Deseryl) 100mg Tab 4250 PHARMACY 3800637Surgicel Fibrillar 560250 PHARMACY 3800638Pentazocine/Naloxone (Talwin NX 50/0.5) 6250 PHARMACY 3800639Fluoxetine (Prozac) 20mg Cap 17250 PHARMACY 3800641Mirtazapine (Remeron) 30mg Tab 11250 PHARMACY 3800642Pregabalin (Lyrica) 75mg Cap 10250 PHARMACY 3800643Ferrous Sulfate 325mg tab 4250 PHARMACY 3800644Ipratropium/Albuterol (Duoneb) 3ml 40250 PHARMACY 3800648Sodium Polystyrene (Kayexalate) 15gm Liq 35250 PHARMACY 3800650Baclofen (Lioresal) 10mg Tab 5636 DRUGS/DETAIL CODE 3800651Oxymorphone (Opana ER) 20mg Tab 30250 PHARMACY 3800652Atenolol (Tenormin) 50mg Tab 6250 PHARMACY 3800653Multivitamin tab 10250 PHARMACY 3800654Aspirin/Butalbital/Caffeine(Fiorinal)Cap 4250 PHARMACY 3800655Ranolazine (Ranexa ER) 500mg Tab 23250 PHARMACY 3800656Sodium Chloride 0.9% 500ml 44258 IV SOLUTIONS 3800657Hydromorphone PCA 30MG/30ML (1mg/1ml) 50636 DRUGS/DETAIL CODE 3800658Succinylcholine (Anectine) 20mg/ml Vial 200636 DRUGS/DETAIL CODE 3800659Meperidine (Demerol) 50mg Tab 6250 PHARMACY 3800660Cisatracurium (Nimbex) 2mg/ml 100250 PHARMACY 3800663Bisacodyl (Dulcolax) 10mg Suppository 4250 PHARMACY 3800664Buprenorphine (Buprenex) 0.3mg/1ml 16250 PHARMACY 3800665Dobutamine 250mg/250ml IVPB Premix 50250 PHARMACY 3800666Propranolol (Inderal) 20mg Tab 4250 PHARMACY 3800667Valproic Acid (Depakote) 500mg Tab 13250 PHARMACY 3800669Allopurinol (Zyloprim) 300mg Tab 4250 PHARMACY 3800670Prednisone 5mg Tab 4636 DRUGS/DETAIL CODE 3800671Dihydrocod 32mg/APAP 712mg/Caffeine 60mg 7250 PHARMACY 3800672Acyclovir (Zovirax 5 %) Oint 1530250 PHARMACY 3800675Butorphanol (Stadol) 1mg/1ml Vial 38250 PHARMACY 3800676Hydrocodone/Acetaminophen(Norco 5/325) 5250 PHARMACY 3800677Venlafaxine (Effexor) 50mg Tab 10250 PHARMACY 3800678Buprenorphine/Naloxone (Suboxone 8/2) 23250 PHARMACY 3800679Atorvastatin (Lipitor) 20mg Tab 15250 PHARMACY 3800682Potassium (KCL) 20meq/100ml IVPB Premix 25258 IV SOLUTIONS 3800683Lidocaine Viscous 15ml 10250 PHARMACY 3800684Diazepam (Valium) 5mg/ml 10ml Vial 12636 DRUGS/DETAIL CODE 3800686Calcium/Vitamin D (Oscal + D) Tab 4250 PHARMACY 3800688Dextrose 5% Norm Saline KCL 20meq 1000ml 100258 IV SOLUTIONS 3800689Isosorbide Mononitrate (Imdur) 30mg Tab 7250 PHARMACY 3800692Tranexamic Acid 1000 mg/10ml 325250 PHARMACY 3800693Nicotine 14mg patch 15250 PHARMACY 3800694Hetastarch 6% (Hespan) 500ml IV 212258 IV SOLUTIONS 3800695Prochloroperazine (Compazine) 10mg Tab 4636 DRUGS/DETAIL CODE

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800696Bisacodyl (Dulcolax) 5mg Tab 4250 PHARMACY 3800698Buprenorphine (Subutex) 2mg Tab 20250 PHARMACY 3800704Hydrocortisone 1% 30gm Cream 11250 PHARMACY 3800710Aspirin (Ecotrin) 325mg Tab 4250 PHARMACY 3800714Hyoscyamine (Levsin) 0.125mg Tab 4250 PHARMACY 3800717Clonazepam (Klonopin) 2mg Tab 5250 PHARMACY 3800724Diltiazem (Cardizem CD) 180mg Cap 6250 PHARMACY 3800732Lidocaine/EPI 1% 30ml Vial 20250 PHARMACY 3800733Nalbuphine (Nubain) 10mg/ml Vial 10636 DRUGS/DETAIL CODE 3800734Sumatriptan (Imitrex) 6mg/0.5ml Vial 300250 PHARMACY 3800735Acyclovir (Zovirax) 200mg Cap 10250 PHARMACY 3800736Polymyxin B (Polymyxin B) Vial 60250 PHARMACY 3800738Daptomycin (Cubicin) 500mg Vial 675636 DRUGS/DETAIL CODE 3800739Terazosin (Hytrin) 5mg Tab 6250 PHARMACY 3800740Guaifenesin (Robitussin) 100mg/5ml 4250 PHARMACY 3800742Sugammadex (Bridion) 100mg/ml Vial 370250 PHARMACY 3800744Ciprofloxacin (Cipro IVPB) 400mg/200ml 125636 DRUGS/DETAIL CODE 3800745Metronidazole (Flagyl) 500mg/100ml IVPB 30250 PHARMACY 3800748Cholecalciferol (Vitamin D) 5000units 10250 PHARMACY 3800749Oxycodone ER (Oxycontin) 30mg Tab 26250 PHARMACY 3800750Sulfasalazine (Azulfidine) 500mg Tab 5250 PHARMACY 3800751Lorazepam (Ativan) 2mg Tab 5250 PHARMACY 3800753Olanzapine (Zyprexa) 5mg Tab 5250 PHARMACY 3800755Nicardipine (Cardene) 20mg/200ml IVPB Pr 360250 PHARMACY 3800756Simvastatin (Zocor) 20mg Tab 18250 PHARMACY 3800757Ceftriaxone (Rocephin) 2gm IVPB PREMIX 51.25636 DRUGS/DETAIL CODE 3800758Modafinil (Provigil) 100mg Tab 8250 PHARMACY 3800759Lubiprostone (Amitiza) 8mcg Tab 23250 PHARMACY 3800760Calcium Gluconate IVPB 1gm/50ml 50250 PHARMACY 3800761Calcium Gluconate IVPB 2gm/100ml 75250 PHARMACY 3800762Phentermine (Adipex) 37.5mg Tab 6250 PHARMACY 3800763Bupivacaine SDV 0.25% 30ml 40250 PHARMACY 3800764Morphine 10mg/5ml Liq 5250 PHARMACY 3800765Hydrocodone/APAP 7.5/325 per 15ML Liq 10.5250 PHARMACY 3800767Isophane insuline(Humulin-N) 60250 PHARMACY 3800768Racepinephrine 2.25 % Nebulizer 5250 PHARMACY 3800769Oxycodone IR (Oxy-IR) 15mg Tab 8250 PHARMACY 3800770Valsartan (Diovan) 160mg Tab 5250 PHARMACY 3800771Telmisartan (Micardis) 80mg Tab 23250 PHARMACY 3800772Acetazolamide (Diamox) 500mg Inj 155636 DRUGS/DETAIL CODE 3800774Estrogen (Premarin Vaginal Cream) 1370250 PHARMACY 3800775Methylprednisolone (Solu-Medrol) 125mg 10636 DRUGS/DETAIL CODE 3800776Ampicillin/Sulbactam 3gm 50636 DRUGS/DETAIL CODE 3800777Meloxicam (Mobic) 15mg Tab 15250 PHARMACY 3800778Methocarbamol (Robaxin) 100mg/ml 10ml Vi 100250 PHARMACY 3800779Enoxaparin (Lovenox) 100mg Syringe 36636 DRUGS/DETAIL CODE 3800780Fentanyl 50mcg/ml 10 ml Vial 60636 DRUGS/DETAIL CODE 3800781Warfarin (Coumadin) 2mg Tab 6250 PHARMACY 3800783Amiodarone 150mg Vial 10636 DRUGS/DETAIL CODE 3800784Fentanyl PCA 1500mcg/30ml (50mcg/1ml) 85636 DRUGS/DETAIL CODE

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800786Thiamine 200mg/2ml 10636 DRUGS/DETAIL CODE 3800787Haloperidol (Haldol) 5mg/ml Vial 17636 DRUGS/DETAIL CODE 3800788Insulin degludec (Tresiba) 100units/ml 500250 PHARMACY 3800789Betazolol (Betoptic) Dropper 192250 PHARMACY 3800790Alprazolam (Xanax) 2mg Tab 8250 PHARMACY 3800792Digoxin (Lanoxin) 0.25mg Tab 4250 PHARMACY 3800793Nifedipine (Procardia ER) 30mg Tab 4250 PHARMACY 3800794Linaclotide (Linzess) 145mcg Cap 52250 PHARMACY 3800795Hydrocodone (Zohydro ER) 30mg Cap 31250 PHARMACY 3800796Canagliflozin (Invokana) 100mg Tab 55250 PHARMACY 3800798Leflunomide (Arava) 10mg Tab 15250 PHARMACY 3800801Torsemide (Demadex) 20mg Tab 5250 PHARMACY 3800803Albumin 5% 50ml 200250 PHARMACY 3800804Levetiracetam (Keppra) 500mg/5ml 12636 DRUGS/DETAIL CODE 3800807Levetiracetam (Keppra) 500mg Tab 4250 PHARMACY 3800809Verapamil ER 180mg Cap 6250 PHARMACY 3800810Fentanyl (Duragesic) 12mcg Patch 55250 PHARMACY 3800811Gadoterate (Dotarem) 7.5mm Vial 150255 DRUGS/INCIDENT RAD 3800812Lamotrigine (Lamactil) 25mg Tab 13250 PHARMACY 3800813Magnesium 1gm/50ml IVPB Premix 20636 DRUGS/DETAIL CODE 3800814Magnesium 2gm/50ml IVPB Premix 45250 PHARMACY 3800815Exenatide (Byetta) 250mcg/ml Syringe 850250 PHARMACY 3800816Linaclotide (Linzess) 72mcg Cap 40250 PHARMACY 3800818Valproic Acid (Depakote) 125mg Tab 5250 PHARMACY 3800820Albumin 250ml 5% 165250 PHARMACY 3800821Hydroxyzine (Vistaril) 25mg Cap 4250 PHARMACY 3800822Barium (Varibar) 240ml 55250 PHARMACY 3800823Lidocaine 0.5% Vial 20250 PHARMACY 3800824Hydromorphone (Dilaudid) 4mg Tab 5250 PHARMACY 3800825Zolmitriptan (Zomid) 2.5mg Tab 83250 PHARMACY 3800826Prazosin (Minipress) 1mg Cap 8250 PHARMACY 3800827Morphine (Avinza) 30mg Cap 15250 PHARMACY 3800828Carbidopa/Levodopa (Sinemet 25/100) Tab 5250 PHARMACY 3800829Iopamidol (Isovue-300) 100ml Vial 48255 DRUGS/INCIDENT RAD 3800830Diatrizoate (Gastrografin) 30ml 34255 DRUGS/INCIDENT RAD 3800831Epinephrine (Epipen) 580250 PHARMACY 3800832Valcyclovir (Valtrex) 500mg Tab 28250 PHARMACY 3800833Pioglitazone (Actos) 15mg Tab 5250 PHARMACY 3800834Iopamidol (Isovue-370) 53255 DRUGS/INCIDENT RAD 3800837Naratriptan (Amerge) 2.5mg Tab 87250 PHARMACY 3800838Barium (Readi-Cat) 15250 PHARMACY 3800839Dakins Solution 60250 PHARMACY 3800840Ceftriaxone (Rocephin) 1gm/50ml Prmx IV 51.1258 IV SOLUTIONS 3800841Prochlorperazine (Compazine) 10mg Vial 20636 DRUGS/DETAIL CODE 3800842Vancomycin 250mg Cap 36250 PHARMACY 3800843Triamcinolone (Nasacort AQ Nasal) Spray 300250 PHARMACY 3800844Pregabalin (Lyrica CR) 82.5mg 50250 PHARMACY 3800845Triamcinolone (Zilretta) 32mg Vial 2200636 DRUGS/DETAIL CODE 3800846Quinidine (Quinaglute) 324mg Tab 25250 PHARMACY 3800847Nifedipine (Procardia XL) 30mg Tab 6250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800848Gentamicin (Garamycin) 40mg/ml (2ml) 9636 DRUGS/DETAIL CODE 3800849Triamcinolone (Zilretta) 32mg Vial 2200636 DRUGS/DETAIL CODE 3800850Mometasone (Nasonex Nasal) 50mcg Spray 366250 PHARMACY 3800851Adenosine (Adenocard) 3mg/2ml Vial 175636 DRUGS/DETAIL CODE 3800852Vancomycin in NS IVPB: 1.75gm/500ml 200636 DRUGS/DETAIL CODE 3800853Bupivacaine (Marcaine 0.5%) 30ml Vial 30250 PHARMACY 3800854Buprenorphine (Belbuca) 75mcg Film 20250 PHARMACY 3800855Benzonate (Tessalon) 100 mg Cap 5250 PHARMACY 3800856Acetaminophen (Tylenol) 650mg Suppos 4250 PHARMACY 3800857Rivaroxaban (Xarelto) 10mg 43250 PHARMACY 3800858Isosorbide Dinitrate 10mg 5250 PHARMACY 3800859Quetiapine (Seroquel) 25mg 5250 PHARMACY 3800860Buprenorphine/Naloxone (Suboxone 2/0.5) 11.28250 PHARMACY 3800861Nystatin Cream 15259 DRUGS/OTHER 3800862Sterile Water 5ml 100250 PHARMACY 3800864Ezetimide (Zetia) 10mg Tab 15250 PHARMACY 3800866Lidocaine/Prilocaine (Emla Cream) 38250 PHARMACY 3800867Nitroglycerin (Nitrostat Subling) 0.4mg 30250 PHARMACY 3800868Nitroglycerin (Nitrobid) 1gm Oint 42250 PHARMACY 3800869Vancomycin in NS IVPB: 2gm / 500ml 200636 DRUGS/DETAIL CODE 3800873Insulin aspart (Novolog 70/30) 122250 PHARMACY 3800878Clopidogrel (Plavix) 75mg Tab 16250 PHARMACY 3800882Etomidate (Amidate) 2mg/ml (10ml) Vial 65250 PHARMACY 3800884Ketorolac (Acular Eye Drops 0.4%) 212250 PHARMACY 3800887Labetalol 100mg Tab 4250 PHARMACY 3800889Enalapril (Vasotec) 10mg Tab 10250 PHARMACY 3800890Nortriptyline 25mg Tab 10250 PHARMACY 3800893Nortriptyline 10mg Tab 10250 PHARMACY 3800894Venlafaxine (Effexor ER) 75mg Tab 10250 PHARMACY 3800904Gelfoam 100 200250 PHARMACY 3800905BSS 15ml 28250 PHARMACY 3800906Muri Lube (Mineral Oil) Vial 10250 PHARMACY 3800907Methylnaltrexone (Relistor) 150mg Tab 70250 PHARMACY 3800908Methenamine/Salicylat (Cystex) 162/162.5 5250 PHARMACY 3800910Sodium Chloride 0.9% AddVantage 250ml 100258 IV SOLUTIONS 3800911Sodium Chloride AddVantage 100ml 25258 IV SOLUTIONS 3800912Sodium Chloride AddVantage 50ml 25258 IV SOLUTIONS 3800918Bupivacaine/EPI 0.5% 30ml 45250 PHARMACY 3800927Sitagliptin (Januvia) 50mg Tab 29250 PHARMACY 3800928Chloroprocaine (Nesacaine) 3% Vial 80636 DRUGS/DETAIL CODE 3800933Gabapentin (Neurontin) 100mg Cap 4250 PHARMACY 3800939Hyaluronic Acid (Synvisc-One) Syringe 119636 DRUGS/DETAIL CODE 3800940Olanzapine (Zyprexa) 10mg Vial 115250 PHARMACY 3800941Norephinephrine (Levophed) Vial 50250 PHARMACY 3800942Phenytoin (Dilantin) 100mg/2ml Vial 8636 DRUGS/DETAIL CODE 3800943Cefdinir (Omnicef) 300mg Cap 5250 PHARMACY 3800944Alteplase (Cathflo) 2mg/1vial 350250 PHARMACY 3800949Mycostatin (Nystatin) 100000units/ml 10250 PHARMACY 3800951Onabotulinumtoxin (Botox) 100units Vial 25636 DRUGS/DETAIL CODE 3800952Ceftazidime (Fortaz) 1gm Vial 60250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3800954Ramipril (Altace) 5mg Tab 10250 PHARMACY 3800958Phenytoin (Dilantin) 100mg Tab 4250 PHARMACY 3800959Digoxin (Lanoxin) 0.5mg/2ml Amp 26636 DRUGS/DETAIL CODE 3800961Glycerin Suppository 4250 PHARMACY 3800962Estradiol 0.5mg 1 tab 5250 PHARMACY 3800965Lidocaine/EPI 2% 20250 PHARMACY 3800966Gabsapentin (Horizant ER) 600mg Tab 50250 PHARMACY 3800970Fluticasone/Salmeterol (Advair 100/50) 450250 PHARMACY 3800975Orphenadrine (Norflex) 100mg Tab 9250 PHARMACY 3800982Metronidazole (Flagyl) 500mg Tab 20250 PHARMACY 3800989Lactulose 10gm/15ml 5250 PHARMACY 3800990Thyroid 30mg Tab 4250 PHARMACY 3800991Lidocaine 2% Jelly 50250 PHARMACY 3800993Dutasteride (Avodart) 0.5mg Cap 15250 PHARMACY 3800994Methocarbamol (Robaxin) 1000mg Vial 70250 PHARMACY 3800997Famotidine (Pepcid) 20mg/2ml Vial 15250 PHARMACY 3801002Glucagon 1mg Vial 320636 DRUGS/DETAIL CODE 3801003Clarithromycin (Biaxin) 500mg Tab 18250 PHARMACY 3801012Pantoprazole (Protonix IV) 40mg Vial 120250 PHARMACY 3801013Sucralfate (Carafate) 1gm Tab 6250 PHARMACY 3801015Chlorodiazepoxide (Librium) 10mg Cap 4636 DRUGS/DETAIL CODE 3801016Niacin 500mg Tab 4250 PHARMACY 3801017Desvenlafaxine (Pristiq ER) 50mg Tab 17250 PHARMACY 3801021Lamotrigine (Lamactil) 100mg Tab 15250 PHARMACY 3801022Metoprolol-ER (Toprol Xl) 25mg Tab 5250 PHARMACY 3801027Metoprolol (Lopressor) 1mg/ml (5ml) Vial 60250 PHARMACY 3801031Oxcarbazepine (Trileptal) 150mg Tab 7250 PHARMACY 3801032Methylphenidate (Ritalin) 10mg Tab 8250 PHARMACY 3801034Cyclosporine (Restasis) Dropper 35250 PHARMACY 3801035Clotrimazole (Lotrimin Cream 1%) Oint 7250 PHARMACY 3801036Insulin glargine (Toujeo) 300units/ml 535250 PHARMACY 3801043Lacosamide (Vimpat) 50mg Tab 20250 PHARMACY 3801046Methylprednisolone (Solu-Medol) 1000mg 90636 DRUGS/DETAIL CODE 3801047Acetaminophen (Tylenol) 325mg Suppos 5250 PHARMACY 3801051Spironolactone (Aldactone) 25mg Tab 4250 PHARMACY 3801055Pseudoephedrine (Sudafed) 30mg Tab 4250 PHARMACY 3801064Silver Sulfadiazine (SSD 1%) Oint 30250 PHARMACY 3801070Tetanus 0.5ml Vaccine 75250 PHARMACY 3801076Morphine 15mg/ml Vial 10250 PHARMACY 3801079Ibuprofen (Motrin) 200mg Tab 4250 PHARMACY 3801082Venlafaxine (Effexor XR) 37.5mg Cap 15250 PHARMACY 3801085Normosol-R 1000ml 100258 IV SOLUTIONS 3801847Potassium 99mg Tab 4250 PHARMACY 3801864Ciprofloxacin (Cipro Eye Drops) 40250 PHARMACY 3801866Carbidopa/Levodopa (Sinemet CR 25/100) 37250 PHARMACY 3801867Diclofenac (Voltaren 1%) Gel 175250 PHARMACY 3801868Otopatadine (Pataday Eye) Dropper 572250 PHARMACY 3801869Dexlanosprazole (Dexilant) 30mg Cap 23250 PHARMACY 3801961Bupropion (Wellbutrin ER) 100mg Tab 6.75250 PHARMACY 3801963Physostigmine 2mg/2ml 150250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3801967Piperacillin/Tazobactam (Zosyn) 3.375gm 54250 PHARMACY 3801968Fluticasone/Vilanter(Breo Ellipta 200/25 550250 PHARMACY 3801969Naloxegol (Movantik) 25mg Tab 31250 PHARMACY 3801970Diltiazem (Cardizem) 30mg Tab 4250 PHARMACY 3801971Mometasone/Formoterol (Dulera 100/5) 685250 PHARMACY 3801973Budesonide(Pulmicort)2.5mg/2ml Nebulizer 23.6250 PHARMACY 3801974Morphine 4mg/ml Vial 5636 DRUGS/DETAIL CODE 3801975Albumin 25% 50ml Vial 200250 PHARMACY 3801976Pneumococcal 13 (Prevnar) Vial 600250 PHARMACY 3801977Apixaban (Eliquis) 5mg Tab 22250 PHARMACY 3801978Diltiazem (Cardizem) 120mg Tab 8250 PHARMACY 3801979Dextrose 50% (D-50-W Syringe) 50ml 36250 PHARMACY 3801982Oxycodone ER (Oxycontin) 15mg Tab 19250 PHARMACY 3801984Tapentadol (Nucynta ER) 50mg Tab 14250 PHARMACY 3801985Metformin (Glucophage) 1000mg Tab 4250 PHARMACY 3801986Tramadol (Ultram ER) 100mg Tab 19250 PHARMACY 3801988Haloperidol (Haldol) 5mg Tab 5250 PHARMACY 3801990Bupivacaine 0.5% (Marcaine 0.5%) Vial 45250 PHARMACY 3801993Gentamicin 40mg/ml 2ml Vial 30636 DRUGS/DETAIL CODE 3801995Cefepime (Maxipime) 1gm Vial 21636 DRUGS/DETAIL CODE 3801996Magnesium 250mg 4250 PHARMACY 3801997Timolol Eye 0.5% (Timoptic) Dropper 70250 PHARMACY 3801998Bimatoprost Eye Drops 0.01% (Lumigan) 500250 PHARMACY 3801999Hydrocodone (Zohydro ER) 10mg Cap 28250 PHARMACY 3802000Aphetamine (Adderall ER) 30mg Tab 20250 PHARMACY 3802001Amino Acid (Procalamine 3%) 1000ml 122250 PHARMACY 3802002Levalbuterol (Xopenex Inhaler) 230250 PHARMACY 3802004Rosuvastatin (Crestor) 10mg Tab 23250 PHARMACY 38020070.45% NS 1000ml + KCL 20meq 100250 PHARMACY 3802010Neosporin GU Irrigant Amp 53250 PHARMACY 3805001CEFAZOLIN/NS IVPB : 1GM/50ML ADDV 165258 IV SOLUTIONS 3805003Cefazolin 2gm 115258 IV SOLUTIONS 3805007GARAMYCIN/NS IVPB : 200MG/100ML 45258 IV SOLUTIONS 3805010Ketamine/NS IVPB : 500MG/500ML 110258 IV SOLUTIONS 3805015VANCOMYCIN 1250MG 224258 IV SOLUTIONS 3805016VANCOMYCIN/NS IVPB : 1500MG/300ML 224258 IV SOLUTIONS 3805017VANCOMYCIN/NS IVPB : 1750MG/500ML 224258 IV SOLUTIONS 3805020VANCOMYCIN/NS IVPB : 2000MG/500ML 224258 IV SOLUTIONS 3805025Amiodarone 150mg/100ml Drip 160258 IV SOLUTIONS 3805027Anastrozole 1mg 4636 DRUGS/DETAIL CODE 3805028VANCOMYCIN 1GM/200ML IVPB PREMIX 69.5636 DRUGS/DETAIL CODE 3805036Methocarbamol (Robaxin) 500mg/5ml Inj 100250 PHARMACY 3805054Gentamycin 40mg/ml 20ml Vial MDV 4636 DRUGS/DETAIL CODE 3805156Cubcin/NS IVPB: 500mg/50ml 681258 IV SOLUTIONS 3805337NF-FLUoxetine HCl Oral Tablet 20MG 48250 PHARMACY 3805338NF-glipiZIDE Tablet 10MG 1250 PHARMACY 3805339NF-FLUoxetine HCl Oral Capsule 40MG 10250 PHARMACY 3805340NF-valsartan Oral Tablet 320MG 19250 PHARMACY 3805341NF-Norvasc Tablet 10MG 32250 PHARMACY 3805342NF-OMEPRAZOLE AVPAK ORAL CAP DR 40MG 22.39250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805343NF-ACTOS ORAL TABLET 30MG 71.26250 PHARMACY 3805344NF-Doxycycline Oral Tablet 50MG 10250 PHARMACY 3805345NF-Lipitor Tablet 80MG 53250 PHARMACY 3805346NF-HydrOXYzine HCl Oral Tablet 10MG 1250 PHARMACY 3805348NF-TraZODone HCl Oral Tablet 50MG 2250 PHARMACY 3805349NF-Simvastatin Oral Tablet 80MG 14250 PHARMACY 3805350NF-PARoxetine HCl Oral Tablet 10MG 7250 PHARMACY 3805352NF-Spironolactone Tablet 50MG 2250 PHARMACY 3805354NF-Januvia Oral Tablet 100MG 54250 PHARMACY 3805355NF-BASAGLAR KWIKPEN SUBQ SOLN 100U/1ML 78.32250 PHARMACY 3805357NF-Chlorthalidone Tablet 50MG 4250 PHARMACY 3805358NF-Estradiol Tablet 2MG 2250 PHARMACY 3805359NF-Venlafaxine HCl Oral Cap ER 150MG 15250 PHARMACY 3805360NF-Coreg Tablet 3.125MG 17250 PHARMACY 3805361NF-Testosterone Topical Gel/Jelly 50MG/5 8250 PHARMACY 3805362NF-Enablex Tablet Extended-Release 15MG 17250 PHARMACY 3805363NF-Fenofibric Acid Oral Cap DR 135MG 16250 PHARMACY 3805365NF-Aubagio Oral Tablet 14MG 876250 PHARMACY 3805366NF-metroNIDAZOLE Topical Cream 0.75% 12250 PHARMACY 3805367NF-Triamterene/HCTZ Capsule 37.5-25MG 1250 PHARMACY 3805370NF-Digoxin Oral Tablet 0.125MG 6250 PHARMACY 3805371NF-glipiZIDE Oral Tab ER 5MG 1250 PHARMACY 3805372NF-Citalopram Oral Tablet 20MG 7250 PHARMACY 3805374NF-hydroCHLOROthiazide Oral Tablet 12.5M 2250 PHARMACY 3805375NF-Belbuca Buccal Mucosa Film 600MCG 45250 PHARMACY 3805376NF-Furosemide Oral Tablet 80MG 1250 PHARMACY 3805377NF-Lyrica Oral Capsule 200MG 28250 PHARMACY 3805378NF-Potassium Chloride Oral Tab ER 20MEQ 1250 PHARMACY 3805381NF-Farxiga Oral Tablet 10MG 37250 PHARMACY 3805382NF-Nature-Throid Oral Tab 97.5MG 1250 PHARMACY 3805383NF-Trulicity SubQ Soln 1.5MG/0.5ML 1366250 PHARMACY 3805384NF-Amitriptyline HCl Oral Tablet 75MG 5250 PHARMACY 3805385NF-Benicar HCT Oral Tablet 40MG-25MG 36250 PHARMACY 3805386NF-Symbicort Inh Aer Liq 160MCG-4.5MCG 122250 PHARMACY 3805387NF-VENTOLIN HFA INHALER 0.09MG/INH 7.87250 PHARMACY 3805391NF-PriLOSEC OTC Tablet DR 20MG 2250 PHARMACY 3805393NF-Mirapex Oral Tablet 1.5MG 25250 PHARMACY 3805394NF-tiZANidine HCl Oral Capsule 2MG 8250 PHARMACY 3805395NF-Trokendi XR Oral Capsule ER 50MG 44250 PHARMACY 3805397NF-amLODIPine-Olmesartan Oral Tab 5MG-20 23250 PHARMACY 3805398NF-CeleXA Tablet 10MG 32250 PHARMACY 3805401NF-TraZODone HCl Oral Tablet 50MG 2250 PHARMACY 3805402NF-ARIPiprazole Oral Tablet 2MG 96250 PHARMACY 3805404NF-Venlafaxine HCl Oral Cap ER 150MG 15250 PHARMACY 3805405NF-Actos Oral Tablet 45MG 77250 PHARMACY 3805407NF-Exforge Oral Tablet 10MG-320MG 45250 PHARMACY 3805408NF-Indapamide Tablet 2.5MG 4250 PHARMACY 3805409NF-Trulicity SubQ Solution 0.75MG/0.5ML 1366250 PHARMACY 3805410NF-Wellbutrin SR 12 Hr Tab ER 150MG 26250 PHARMACY 3805411NF-TraZODone HCl Oral Tablet 50MG 3250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805412NF-benazepril HCl-HCTZ Tab 20MG-12.5MG 6250 PHARMACY 3805414NF-Timolol Maleate Ophth Solution 0.25% 8250 PHARMACY 3805415NF-Trusopt Ocumeter Ophth Solution 2% 20250 PHARMACY 3805416NF-Zithromax Z-Pak Tablet 250MG 123250 PHARMACY 3805417NF-Zithromax Z-Pak Tablet 250MG 123250 PHARMACY 3805420NF-Synthroid Oral Tablet 137MCG 4250 PHARMACY 3805421NF-Glyxambi Oral Tablet 10MG-5MG 64250 PHARMACY 3805422NF-Ramipril Oral Capsule 2.5MG 5250 PHARMACY 3805423NF-Trilipix Delayed Release Capsule 135M 30250 PHARMACY 3805424NF-Baclofen Oral Tablet 20MG 15250 PHARMACY 3805426NF-Testosterone Cypionate IM Oil 200MG/1 30250 PHARMACY 3805427NF-Viibryd Oral Tablet 10MG 32250 PHARMACY 3805428NF-Irbesartan and HCTZ Tablet 300-12.5MG 12250 PHARMACY 3805429NF-OXcarbazepine Oral Tablet 300MG 7250 PHARMACY 3805430NF-Simvastatin Oral Tablet 10MG 8250 PHARMACY 3805431NF-Viibryd Oral Tablet 40MG 32250 PHARMACY 3805433NF-Pazeo Ophthalmic Solution 0.7% 280250 PHARMACY 3805434NF-Irbesartan Oral Tablet 150MG 9250 PHARMACY 3805435NF-Xanax Oral Tablet 1MG 25250 PHARMACY 3805436NF-Lidocaine/Prilocaine Top Cream 2.5%-2 5250 PHARMACY 3805437NF-Vistaril Capsule 50MG 10250 PHARMACY 3805438NF-Losartan/Hctz Oral Tablet 100MG-12.5M 10250 PHARMACY 3805439NF-Thioridazine HCl Tablet 10MG 1250 PHARMACY 3805440NF-Topiramate Oral Tablet 200MG 21250 PHARMACY 3805441NF-PROzac Capsule 20MG 56250 PHARMACY 3805442NF-Rosuvastatin Calcium Oral Tablet 20MG 26250 PHARMACY 3805443NF-Vitamin D Oral Tablet 5000IU 5250 PHARMACY 3805445NF-alosetron hcl Oral Tablet 0.5MG 78250 PHARMACY 3805446NF-Atomoxetine Oral Capsule 60MG 46250 PHARMACY 3805447NF-Candesartan Cilexetil Oral Tablet 32M 13250 PHARMACY 3805448NF-Doxycycline Oral Capsule 50MG 4250 PHARMACY 3805449NF-Glycopyrrolate Oral Tablet 2MG 6250 PHARMACY 3805450NF-RABEprazole Sodium Oral Tab EC 20MG 30250 PHARMACY 3805452NF-NP Thyroid Oral Tablet 90MG 3250 PHARMACY 3805454NF-Xyzal Allergy 24HR Oral Tablet 5MG 2250 PHARMACY 3805455NF-THYROID PORCINE PWD 10.77250 PHARMACY 3805456NF-THYROID TAB 60MG 1.61250 PHARMACY 3805458NF-Synjardy Oral Tablet 5MG-1000MG 29250 PHARMACY 3805459NF-Chlorthalidone Tablet 25MG 6250 PHARMACY 3805460NF-Estarylla Oral Tablet 3250 PHARMACY 3805461NF-Citalopram Oral Tablet 10MG 7250 PHARMACY 3805463NF-Carvedilol Oral Tablet 3.125MG 6250 PHARMACY 3805464NF-Carvedilol Oral Tablet 6.25MG 6250 PHARMACY 3805465NF-Probiotic Digestive Support Oral Caps 1250 PHARMACY 3805466NF-Tresiba Subcutaneous Solution 200U/1M 244250 PHARMACY 3805467NF-Flecainide Acetate Tablet 100MG 10250 PHARMACY 3805468NF-hydrALAZINE HCl Tab 50MG 1250 PHARMACY 3805470NF-Bystolic Oral Tablet 20MG 17250 PHARMACY 3805471NF-Ezetimibe-Simvastatin Tablet 10MG-10M 33250 PHARMACY 3805473NF-Rosuvastatin Calcium Oral Tablet 20MG 26250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805474NF-Spiriva Respimat Inh Spray 1.25MCG/1A 386250 PHARMACY 3805476NF-XARELTO ORAL TABLET 20MG 53.76250 PHARMACY 3805477NF-XARELTO ORAL TABLET 20MG 53.76250 PHARMACY 3805478NF-dilTIAZem HCl Oral Capsule, ER 420MG 5250 PHARMACY 3805479NF-Pristiq Extended-Release Tablet 100MG 48250 PHARMACY 3805480NF-CeleXA Tablet 20MG 34250 PHARMACY 3805481NF-Crestor Oral Tablet 5MG 31250 PHARMACY 3805482NF-traZODone hydrochloride Oral Tab 150M 8250 PHARMACY 3805483NF-HCTZ/Triamterene Tablet 25MG-37.5MG 1250 PHARMACY 3805485NF-Clobetasol Prop Topical Ointment 0.05 2250 PHARMACY 3805486NF-Enstilar Topical Foam 0.064%-0.005% 63250 PHARMACY 3805487NF-Fluocinonide Topical Ointment 5% 14250 PHARMACY 3805490NF-Zaditor Ophthalmic Solution 0.025% 7250 PHARMACY 3805491NF-Provigil Oral Tablet 200MG 201250 PHARMACY 3805492NF-Triamterene/HCTZ Capsule 37.5-25MG 1250 PHARMACY 3805494NF-Prevacid Delayed-Release Capsule 30MG 17250 PHARMACY 3805497NF-doxazosin Oral Tablet 4MG 4250 PHARMACY 3805498NF-Arnuity Ellipta Inh Pwd 100MCG/1ACT 20250 PHARMACY 3805501NF-Glimepiride Oral Tablet 1MG 1250 PHARMACY 3805504NF-Claritin-D 24HR Oral Tab ER 10MG-240M 3250 PHARMACY 3805509NF-Potassium Citrate Oral Tablet ER 10ME 8250 PHARMACY 3805510Aciphex Enteric Coated Tablet 20MG-NF 62250 PHARMACY 3805512NF-Delzicol Oral Cap DR 400MG 13250 PHARMACY 3805513NF-Evista Oral Tablet 60MG 23250 PHARMACY 3805514NF-Remeron Tablet 15MG 19250 PHARMACY 3805515NF-Cefuroxime Axetil Tablet 500MG 24250 PHARMACY 3805516NF-Estradiol TD Patch ER 0.075MG/24HR 73250 PHARMACY 3805519NF-Progesterone Oral Capsule 200MG 11250 PHARMACY 3805521NF-Zomig Oral Tablet 5MG 423250 PHARMACY 3805522NF-dilTIAZem HCl Oral Capsule, ER 180MG 2250 PHARMACY 3805523NF-Sertraline Oral Tablet 25MG 8250 PHARMACY 3805524NF-Lovastatin Oral Tablet 20MG 8250 PHARMACY 3805525NF-Albuterol HFA Inh Aer Pwd 0.09MG/1ACT 17250 PHARMACY 3805527NF-Oxybutynin Oral Tab ER 10MG 23250 PHARMACY 3805529NF-Captopril Oral Tablet 50MG 8250 PHARMACY 3805530NF-Dulera Inh Aer Pwd 5MCG-200MCG/Act 86250 PHARMACY 3805531NF-LEVOTHYROXINE SODIUM ORAL TABLET 137M 1.8250 PHARMACY 3805532NF-buPROPion XL Oral Tab ER 24 HR 300MG 18250 PHARMACY 3805533NF-Potassium Chloride Oral Tab ER 20MEQ 1250 PHARMACY 3805535NF-HumaLOG SubQ Soln 100U/1ML 122250 PHARMACY 3805536NF-Zoloft Tablet 100MG 40250 PHARMACY 3805537NF-Tarka Tablet 4MG-240MG 21250 PHARMACY 3805539NF-amLODIPine Besylate Oral Tablet 2.5MG 5250 PHARMACY 3805540NF-Irbesartan Oral Tablet 150MG 9250 PHARMACY 3805541NF-ARIPiprazole Oral Tablet 10MG 96250 PHARMACY 3805542NF-buPROPion HCl XL Tab ER 300MG 18250 PHARMACY 3805546NF-Lovaza Oral Liquid Filled Capsule 1GM 3250 PHARMACY 3805547NF-Neurontin Tablet 800MG 8250 PHARMACY 3805550NF-Trokendi XR Oral Capsule ER 200MG 121250 PHARMACY 3805552NF-Maxalt Tablet 10MG 131250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805553NF-Stiolto Respimat Inh 2.5-2.5MCG/1Act 357250 PHARMACY 3805554NF-Terbinafine Hydrochloride Tablet 250M 39250 PHARMACY 3805555NF-Topiramate Oral Tablet 50MG 15250 PHARMACY 3805556NF-Trileptal Oral Tablet 600MG 57250 PHARMACY 3805557NF-Trileptal Oral Tablet 600MG 30250 PHARMACY 3805558NF-Zofran Tablet 8MG 139250 PHARMACY 3805561NF-Crestor Oral Tablet 20MG 31250 PHARMACY 3805562NF-valACYclovir Oral Tablet 1GM 37250 PHARMACY 3805563NF-Divigel TD Gel 0.5MG/1Packet 10250 PHARMACY 3805564NF-Hiprex Tablet 1GM 10250 PHARMACY 3805565NF-metOLazone Oral Tablet 5MG 4250 PHARMACY 3805566NF-Micardis Tablet 40MG 25250 PHARMACY 3805567NF-Paxil Oral Tablet 10MG 12250 PHARMACY 3805568NF-Synthroid Oral Tablet 175MCG 4250 PHARMACY 3805569NF-LEVOTHYROXINE SODIUM LIQ CAP 137MCG 15.37250 PHARMACY 3805570NF-Detrol LA Oral Capsule ER 4MG 43250 PHARMACY 3805571NF-THYROID TAB 60MG 2.75250 PHARMACY 3805572NF-Cyproheptadine Hydrochloride Tablet 4 1250 PHARMACY 3805574NF-Tolterodine Tartrate Oral Cap ER 4MG 24250 PHARMACY 3805575NF-Torsemide Oral Tablet 5MG 1250 PHARMACY 3805576NF-Bisoprolol/HCTZ 10MG-6.25MG Tablet 4250 PHARMACY 3805577Activella Oral Tablet 0.5MG-0.1MG-NF 25250 PHARMACY 3805578NF-Ipratropium Bromide Inh/Neb 0.02% 1250 PHARMACY 3805579NF-Omeprazole Tablet Delayed Release 20M 1250 PHARMACY 3805580NF-Potassium Chloride Oral Cap ER 10MEQ 2250 PHARMACY 3805581NF-BISOPROLOL/HCTZ ORAL TABLET 5MG-6.25M 3.15250 PHARMACY 3805583NF-Metoprolol Succinate Tab ER 100MG 5250 PHARMACY 3805586NF-Lipitor Tablet 10MG 37250 PHARMACY 3805587NF-Progesterone Oral Liquid Capsule 200M 12250 PHARMACY 3805588Flu Vaccine 2019-20 105250 PHARMACY 3805589Abilify Oral Tablet 2MG - NF 107250 PHARMACY 3805590NF-Topiramate Oral Tablet 50MG 13250 PHARMACY 3805591NF-Levothyroxine Sodium Oral Tablet 137M 2250 PHARMACY 3805592NF-Refresh Ophth Solution 1250 PHARMACY 3805597NF-buPROPion HCl Tab ER 150MG 5250 PHARMACY 3805598NF-hydrOXYzine HCl Oral Tablet 10MG 1250 PHARMACY 3805599NF-Citalopram Oral Tablet 10MG 7250 PHARMACY 3805600NF-predniSONE Oral Tablet 1MG 1250 PHARMACY 3805602NF-Coreg Tablet 25MG 17250 PHARMACY 3805603NF-Bethanechol Oral Tab 50MG 12250 PHARMACY 3805605NF-Amitriptyline Oral Tablet 50MG 3250 PHARMACY 3805606NF-Oxybutynin Chloride Oral Tab ER 15MG 10250 PHARMACY 3805607NF-Prazosin HCl Oral Capsule 2MG 1250 PHARMACY 3805608NF-Systane Ultra Ophthalmic Soln 0.4%-0. 3250 PHARMACY 3805609NF-Topamax Oral Capsule 25MG 24250 PHARMACY 3805611NF-amLODIPine Besylate Oral Tablet 10MG 7250 PHARMACY 3805613NF-Lisinopril-HCTZ Tablet 20MG-25MG 3250 PHARMACY 3805614NF-Lovastatin Oral Tablet 40MG 12250 PHARMACY 3805615NF-Vyvanse Oral Capsule 60MG 36250 PHARMACY 3805618NF-Venlafaxine HCl Oral Tab ER 75MG 11250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805619NF-Butalbital-Acetaminophen Tab 50MG-300 43250 PHARMACY 3805620NF-Brimonidine Tartrate Ophth Solution 0 19250 PHARMACY 3805621NF-Flonase Sensimist Spray 27.5MCG/1Act 7250 PHARMACY 3805622NF-Gralise Oral Tablet 300MG 33250 PHARMACY 3805623NF-Levothyroxine Oral Tablet 200MCG 1250 PHARMACY 3805625NF-Pantoprazole Sodium Oral Tablet EC 20 32250 PHARMACY 3805626NF-Geritol Complete Tablet 4250 PHARMACY 3805627NF-busPIRone Oral Tablet 5MG 2250 PHARMACY 3805631NF-PriLOSEC Oral Capsule DR 10MG 17250 PHARMACY 3805633NF-Latuda Oral Tablet 40MG 146250 PHARMACY 3805634NF-Lexapro Tablet 20MG 43250 PHARMACY 3805635NF-Align Oral Capsule 4MG 2250 PHARMACY 3805636NF-Colestid Oral Tablet 1GM 7250 PHARMACY 3805640NF-FLUoxetine HCl Oral Capsule 20MG 8250 PHARMACY 3805642NF-Latuda Oral Tablet 40MG 146250 PHARMACY 3805643NF-dilTIAZem HCl Oral Capsule, ER 300MG 5250 PHARMACY 3805645NF-Maxzide Tablet 25MG-37.5MG 1250 PHARMACY 3805646NF-Metoprolol Tartrate Oral Tablet 100MG 2250 PHARMACY 3805647NF-prednisoLONE Acetate Ophth Suspension 33250 PHARMACY 3805648NF-Steglatro Oral Tablet 5MG 33250 PHARMACY 3805650NF-Forteo Subcutaneous Solution 250MCG/1 5139250 PHARMACY 3805652NF-Detrol LA Oral Capsule ER 4MG 43250 PHARMACY 3805653NF-Lasix Tablet 80MG 4250 PHARMACY 3805654NF-Potassium Cl PowderforSolution 20MEQ 32250 PHARMACY 3805655NF-Colcrys Oral Tablet 0.6MG 17250 PHARMACY 3805657NF-clonazePAM Tablet 1MG 2250 PHARMACY 3805658NF-Multaq Oral Tablet 400MG 39250 PHARMACY 3805659NF-Quinapril Oral Tablet 20MG 3250 PHARMACY 3805662NF-rOPINIRole Hydrochloride Tablet 0.5MG 7250 PHARMACY 3805663NF-Fenofibrate Oral Capsule 134MG 5250 PHARMACY 3805666NF-Vytorin Oral Tablet 10MG-40MG 41250 PHARMACY 3805667NF-raNITIdine Oral Capsule 150MG 4250 PHARMACY 3805668NF-Qvar Inh/Neb Aer Liq 0.04MG/1ACT 43250 PHARMACY 3805670NF-Microgestin 1/20 Oral Tablet 10250 PHARMACY 3805672NF-Gabapentin Oral Tablet 800MG 9250 PHARMACY 3805674NF-Propranolol Hydrochloride Tablet 80MG 2250 PHARMACY 3805675NF-glipiZIDE Tablet 10MG 1250 PHARMACY 3805676NF-HumaLOG KwikPen SubQ Soln 100U/ML 127250 PHARMACY 3805678NF-Estradiol/Norethindrone Acetate 1-0.5 14250 PHARMACY 3805679NF-PARoxetine Hydrochloride Tab ER 25MG 17250 PHARMACY 3805680NF-Pioglitazone Oral Tablet 30MG 32250 PHARMACY 3805683NF-Atrovent HFA Soln Inh Oral/Neb 108250 PHARMACY 3805684NF-Lotrel Oral Capsule 10MG-40MG 46250 PHARMACY 3805687NF-Lyrica Oral Capsule 150MG 28250 PHARMACY 3805688NF-Trokendi XR Oral Capsule ER 25MG 34250 PHARMACY 3805689NF-Candesartan Cilexetil Oral Tablet 16M 9250 PHARMACY 3805690NF-Betamethasone Dipropionate Lotion 0.0 2250 PHARMACY 3805691NF-levocetirizine DiHCl Oral Tablet 5MG 9250 PHARMACY 3805692NF-metFORMIN HCl Tab ER 24HR 500MG 51250 PHARMACY 3805693NF-Minocycline Oral Capsule 100MG 5250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805695NF-Testosterone Cypionate Intramuscular 25250 PHARMACY 3805698NF-Doxepin HCl Oral Capsule 50MG 3250 PHARMACY 3805700NF-Midodrine HCl Tablet 10MG 14250 PHARMACY 3805701NF-Propranolol Hydrochloride Cap ER 60MG 3250 PHARMACY 3805702NF-Topiramate Oral Tablet 100MG 16250 PHARMACY 3805703NF-Lotrel Capsule 5MG-10MG 34250 PHARMACY 3805704NF-Escitalopram Oral Tablet 20MG 13250 PHARMACY 3805706NF-Mirapex Oral Tablet 1MG 25250 PHARMACY 3805707NF-Pregabalin Oral Cap 50MG 25250 PHARMACY 3805708NF-Lisinopril Oral Tablet 30MG 4250 PHARMACY 3805710NF-Fluorometholone Ophth Suspension 0.1% 51250 PHARMACY 3805711NF-lamoTRIgine Oral Tablet 200MG 17250 PHARMACY 3805712NF-Muro-128 Ophth Ointment 5% 13250 PHARMACY 3805716NF-Bisoprolol Fumarate Tablet 5MG 3250 PHARMACY 3805718NF-Tolterodine Tartrate Oral Cap ER 4MG 24250 PHARMACY 3805719NF-Adult Probiotic Oral Capsule 1250 PHARMACY 3805720NF-Propranolol Hydrochloride Tablet 10MG 1250 PHARMACY 3805721NF-rizatriptan benzoate Oral Tablet 5MG 94250 PHARMACY 3805722NF-Pravastatin Sodium Oral Tablet 80MG 14250 PHARMACY 3805723NF-JANUMET ORAL TABLET 50MG-1000MG 27.07250 PHARMACY 3805724NF-Colestipol Oral Tablet 1GM 5250 PHARMACY 3805725NF-Premarin Tablet 1.25MG 20250 PHARMACY 3805726NF-Citalopram Oral Tablet 20MG 7250 PHARMACY 3805727NF-Anoro Ellipta Inhalation Powder 24250 PHARMACY 3805728NF-Benazepril Oral Tablet 20MG 4250 PHARMACY 3805729NF-Topamax Oral Tablet 50MG 43250 PHARMACY 3805730NF-carBAMazepine Oral Tab ER 200MG 6250 PHARMACY 3805731NF-Divalproex Sodium Oral Tab ER 250MG 7250 PHARMACY 3805733NF-buPROPion HCl 24 Hr Tab ER 300MG 18250 PHARMACY 3805734NF-Advair HFA 230/21 Inh Aer 230MCG-21MC 155250 PHARMACY 3805735NF-Fexofenadine Oral Tablet 60MG 4250 PHARMACY 3805736NF-amLODIPine/Benazepril HCl Cap 10MG-20 9250 PHARMACY 3805738NF-Omeprazole Delayed Release Capsule 40 22250 PHARMACY 3805739NF-tiZANidine HCl Oral Capsule 4MG 10250 PHARMACY 3805740NF-Androgel Topical Gel 1.62% 29250 PHARMACY 3805741NF-Prochlorperazine Oral Tablet 5MG 1250 PHARMACY 3805743NF-Edarbi Oral Tablet 40MG 14250 PHARMACY 3805744NF-Synthroid Oral Tablet 50MCG 4250 PHARMACY 3805746NF-Carvedilol Oral Tablet 25MG 6250 PHARMACY 3805749NF-NP Thyroid 120 Oral Tablet 76MCG-18MC 4250 PHARMACY 3805751NF-THYROID TAB 120MG 7.47250 PHARMACY 3805752NF-Kadian Capsule, Extended Release 10MG 34250 PHARMACY 3805753NF-Potassium Chloride Oral Cap ER 8MEQ 2250 PHARMACY 3805755NF-Doxepin Oral Capsule 25MG 2250 PHARMACY 3805757NF-Trintellix Oral Tablet 10MG 38250 PHARMACY 3805758NF-Xigduo XR Oral Tablet ER 5MG-1000MG 29250 PHARMACY 3805759NF-OXYBUTYNIN CHLORIDE ORAL TAB ER 15MG 10.12250 PHARMACY 3805760Acyclovir Oral Tablet 800MG-NF 10250 PHARMACY 3805761NF-Forteo Subcutaneous Solution 250MCG/1 5139250 PHARMACY 3805763NF-buPROPion HCl Tab ER 150MG 5250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805764NF-glyBURIDE and metFORMIN Tab 2.5MG-500 3250 PHARMACY 3805765NF-Modafinil Oral Tablet 200MG 100250 PHARMACY 3805766NF-Sunosi Oral Tablet 150MG 79250 PHARMACY 3805767NF-amLODIPine Besylate/Atorvastatin Calc 28250 PHARMACY 3805768NF-Humira Pen Starter 80MG/0.8ML 18626250 PHARMACY 3805769NF-FLUoxetine HCl Oral Capsule 10MG 7250 PHARMACY 3805770NF-Ortho Tri-Cyclen Lo Oral Kit 19250 PHARMACY 3805771NF-Adderall Oral Tablet 20MG 25250 PHARMACY 3805772NF-Ondansetron Disintegrating Tablet 4MG 66250 PHARMACY 3805773NF-Junel 1.5/30 Oral Tablet 4250 PHARMACY 3805774NF-Matzim LA Oral 24HR Tab ER 360MG 14250 PHARMACY 3805775NF-valsartan Oral Tablet 40MG 11250 PHARMACY 3805776NF-Astelin Ready-Spray Nasal 14250 PHARMACY 3805777NF-Glyxambi Oral Tablet 25MG-5MG 64250 PHARMACY 3805778NF-Candesartan Cilexetil Oral Tablet 16M 9250 PHARMACY 3805779NF-busPIRone HCl Oral Tablet 15MG 6250 PHARMACY 3805780NF-Toprol XL Tablet 100MG 7250 PHARMACY 3805785NF-Invokana Oral Tablet 300MG 59250 PHARMACY 3805787 NF-OLMESARTAN MEDOXOMIL-HYDROCHLOROTHIAZ 14.45 250 PHARMACY 3805788NF-MINOXIDIL ORAL TABLET 10MG 6.35250 PHARMACY 3805789NF-Soma Oral Tablet 250MG 23250 PHARMACY 3805791NF-Keppra Oral Tablet 1000MG 56250 PHARMACY 3805792NF-Vimpat Oral Tablet 150MG 54250 PHARMACY 3805793NF-amLODIPine Besylate Oral Tablet 10MG 6250 PHARMACY 3805795NF-Potassium Chloride Oral Tab ER 20MEQ 1250 PHARMACY 3805796NF-azaTHIOprine Oral Tablet 50MG 6250 PHARMACY 3805797NF-Lisinopril-HCTZ Oral Tablet 20MG-25MG 3250 PHARMACY 3805800NF-Pravastatin Sodium Oral Tablet 10MG 9250 PHARMACY 3805801NF-Remeron Tablet 45MG 22250 PHARMACY 3805803NF-Esomeprazole Magnesium Capsule DR 40M 26250 PHARMACY 3805806NF-Minoxidil Tablet 10MG 3250 PHARMACY 3805808NF-Premarin Oral Tablet 0.625MG 20250 PHARMACY 3805809NF-raNITIdine Oral Capsule 150MG 4250 PHARMACY 3805810NF-BUSPIRONE HCL ORAL TABLET 5MG 2.24250 PHARMACY 3805811NF-naltrexone Route Not Applicable Powde 877250 PHARMACY 3805813NF-Carvedilol Oral Capsule ER 10MG 30250 PHARMACY 3805816Chantix 1mg 29636 DRUGS/DETAIL CODE 3805817NF-EstroGel Transdermal Gel 0.06% 3250 PHARMACY 3805818NF-lamoTRIgine Oral Tab ER 50MG 39250 PHARMACY 3805819NF-raNITIdine Oral Capsule 300MG 8250 PHARMACY 3805820NF-Novaplus Depo-Testosterone IM 200MG/1 72250 PHARMACY 3805823NF-Qvar Redihaler Inh Aerosol Liq 0.04MG 60250 PHARMACY 3805824NF-Naltrexone HCl Oral Tablet 50MG 11250 PHARMACY 3805825NF-EstroGel Transdermal Gel 0.06% 3250 PHARMACY 3805826NF-Pramipexole Dihydrochloride Tablet 1M 9250 PHARMACY 3805827NF-Candesartan Cilexetil Oral Tablet 8MG 9250 PHARMACY 3805828NF-Fenofibric Acid Oral Capsule DR 135MG 17250 PHARMACY 3805829NF-Fetzima Capsule Extended Release 120M 47250 PHARMACY 3805830NF-Memantine HCl Oral Tablet 5MG 18250 PHARMACY 3805831NF-Leflunomide Oral Tablet 20MG 49250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805832NF-Doxycycline Oral Capsule 100MG 4250 PHARMACY 3805833NF-Qvar Inh/Neb Aer Liq 0.08MG/1ACT 57250 PHARMACY 3805834NF-Wellbutrin Oral Tablet 100MG 5250 PHARMACY 3805835NF-Acyclovir Oral Tablet 400MG 5250 PHARMACY 3805838NF-Irbesartan and HCTZ Tab 300MG-12.5MG 2250 PHARMACY 3805839NF-Desloratadine Oral Tablet 5MG 15250 PHARMACY 3805840NF-Donepezil HCl Oral Tablet 23MG 34250 PHARMACY 3805842NF-Namenda Tablet 10MG 26250 PHARMACY 3805843NF-Nitroglycerin TD Patch ER 0.4MG/1Hr 3250 PHARMACY 3805845NF-Fluconazole Tablet 150MG 41250 PHARMACY 3805846NF-Toviaz Oral Extended Release Tablet 8 39250 PHARMACY 3805847NF-NAMENDA XR CAP ER 28MG 55.77250 PHARMACY 3805849NF-ISOSORBIDE MONONITRATE TAB 20MG 2.68250 PHARMACY 3805850NF-Simvastatin Oral Tablet 10MG 8250 PHARMACY 3805853NF-Amitriptyline Oral Tablet 10MG 2250 PHARMACY 3805854NF-Irbesartan Oral Tablet 150MG 1250 PHARMACY 3805855NF-Prempro Oral Tablet 0.625MG-2.5MG 24250 PHARMACY 3805858NF-NIFEdipine Oral Tab ER 90MG 8250 PHARMACY 3805859NF-Nature-Throid Oral Tablet 32.5MG 1250 PHARMACY 3805861NF-Valsartan and hydroCHLOROthiazide Tab 16250 PHARMACY 3805863NF-Irbesartan Oral Tablet 300MG 1250 PHARMACY 3805865NF-Levothyroxine Sodium Oral Tablet 75MC 1250 PHARMACY 3805866NF-LORazepam Oral Tablet 0.5MG 2250 PHARMACY 3805867NF-Finacea Topical Gel 15% 24250 PHARMACY 3805868NF-levETIRAcetam Oral Tablet 1000MG 21250 PHARMACY 3805869NF-levETIRAcetam Oral Tablet 250MG 8250 PHARMACY 3805870NF-Rosuvastatin Calcium Oral Tablet 5MG 26250 PHARMACY 3805872NF-miSOPROStol Tablet 100mcg 2250 PHARMACY 3805873NF-Telmisartan Oral Tablet 40MG 16250 PHARMACY 3805874NF-Spiriva Respimat Inh Spray 2.5MCG/1Ac 386250 PHARMACY 3805875NF-Keppra Oral Tablet 750MG 11250 PHARMACY 3805880NF-Nortriptyline HCl Capsule 25MG 4250 PHARMACY 3805881NF-PriLOSEC Capsule 20MG 4250 PHARMACY 3805883NF-Triamterene and HCTZ Tab 37.5MG-25MG 1250 PHARMACY 3805884NF-Dicyclomine HCl Tablet 20MG 2250 PHARMACY 3805886NF-Bisoprolol Fumarate Tablet 5MG 3250 PHARMACY 3805887NF-Mirtazapine Tablet 15MG 8250 PHARMACY 3805889NF-Fluocinonide TopicalEmollientCream 0. 9250 PHARMACY 3805891NF-raNITIdine Oral Tablet 300MG 8250 PHARMACY 3805892NF-HumaLOG KwikPen SubQ Soln 200U/ML 254250 PHARMACY 3805894NF-Stiolto Respimat Inst Pack 10ACT 67250 PHARMACY 3805895NF-metFORMIN HCl Tab ER, 24HR 1000MG 94250 PHARMACY 3805896NF-Rosuvastatin Calcium Oral Tablet 20MG 26250 PHARMACY 3805897NF-Soliqua SC Solution 100U-33MCG/1ML 169250 PHARMACY 3805898NF-Bactrim Oral Tablet 400MG-80MG 5250 PHARMACY 3805899NF-Cellcept Capsule 250MG 32250 PHARMACY 3805900NF-Envarsus XR Tab Extended Release 0.75 14250 PHARMACY 3805901NF-Prograf Capsule 0.5MG 5250 PHARMACY 3805902NF-Prograf Capsule 1MG 9250 PHARMACY 3805903NF-Venlafaxine HCl Oral Tab ER 150MG 12250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805904NF-dilTIAZem CD 24 Hr Cap 240MG 9250 PHARMACY 3805905NF-LaMICtal Tablet 200MG 5250 PHARMACY 3805906NF-busPIRone HCl Oral Tablet 7.5MG 4250 PHARMACY 3805907NF-Pioglitazone Oral Tablet 45MG 34250 PHARMACY 3805908NF-Flovent Inhaler 0.11MG/Act 72250 PHARMACY 3805909NF-Imbruvica Oral Capsule 140MG 517250 PHARMACY 3805910NF-Sprintec Tablet 3250 PHARMACY 3805911NF-Potassium Chloride Oral Tab ER 20MEQ 1250 PHARMACY 3805912NF-Amitiza Liquid Capsule 24MCG 22250 PHARMACY 3805913NF-Amitriptyline HCl Oral Tablet 150MG 6250 PHARMACY 3805914NF-Letrozole Oral Tablet 2.5MG 54250 PHARMACY 3805915NF-Augmentin Oral Tablet 500MG-125MG 17250 PHARMACY 3805916NF-Tamoxifen Tablet 20MG 11250 PHARMACY 3805917NF-Brilinta Oral Tablet 90MG 22250 PHARMACY 3805919NF-rOPINIRole Hydrochloride Tablet 2MG 7250 PHARMACY 3805921NF-Paxil Oral Tablet 40MG 14250 PHARMACY 3805922NF-busPIRone HCl Oral Tablet 15MG 6250 PHARMACY 3805923NF-Clobetasol Propionate TopicalCream 0. 5250 PHARMACY 3805925NF-TraZODone Hydrochloride Oral Tablet 5 5250 PHARMACY 3805926NF-Xanax Oral Tablet 0.25MG 15250 PHARMACY 3805927NF-Edarbyclor Oral Tablet 40MG-12.5MG 15250 PHARMACY 3805928NF-Vascepa Oral Liquid Filled Cap 1GM 9250 PHARMACY 3805930NF-Vivelle-Dot Transderm Patch 0.05MG/24 60250 PHARMACY 3805931NF-buPROPion HCl Oral Tab ER, 12HR 5250 PHARMACY 3805932NF-sulfADIAZINE Tablet 500MG 15250 PHARMACY 3805933NF-Sotalol HCl Tablet 120MG 10250 PHARMACY 3805934NF-Levothyroxine Oral Tablet 50MCG 1250 PHARMACY 3805935NF-Bisoprolol/Hctz Oral Tablet 5MG-6.25M 7250 PHARMACY 3805936NF-Livalo Oral Tablet 1MG 16250 PHARMACY 3805937NF-valACYclovir Oral Tablet 1GM 37250 PHARMACY 3805938NF-Lovenox Injection Solution 80MG/0.8ML 298250 PHARMACY 3805939NF-Lisinopril Tablet 20mg 3250 PHARMACY 3805940NF-Omeprazole Oral Tablet DR 20MG 1250 PHARMACY 3805941NF-Topiramate Oral Tablet 50MG 14250 PHARMACY 3805942NF-Pregabalin Oral Cap 300MG 25250 PHARMACY 3805943NF-IFE-BIMIX 30/1 30MG-1MG/1ML 225.27250 PHARMACY 3805944NF-Alendronate Sod Oral Tablet 70MG 57250 PHARMACY 3805946NF-Desvenlafaxine Oral Tablet ER 100MG 17250 PHARMACY 3805947NF-Fludrocortisone Acetate Tablet 0.1MG 2250 PHARMACY 3805949NF-Midodrine HCl Oral Tablet 5MG 7250 PHARMACY 3805952NF-Ipratropium Bromide Nasal Spray 0.03% 4250 PHARMACY 3805955NF-Combigan Ophth Soln 0.2%-0.5% 126250 PHARMACY 3805956NF-Metoprolol Succinate Tab ER 200MG 8250 PHARMACY 3805957NF-ROPINIROLE HCL TAB 0.25MG 7.51250 PHARMACY 3805959NF-Larin 1.5/30 Oral Tablet 30MCG-1.5MG 4250 PHARMACY 3805960NF-Levothyroxine Oral Tablet 200MCG 1250 PHARMACY 3805961NF-Liothyronine Sodium Oral Tablet 25MCG 3250 PHARMACY 3805962NF-Minocycline Oral Capsule 50MG 9250 PHARMACY 3805963NF-Mirena Insert ER 52MG 3432250 PHARMACY 3805964NF-Nystatin Oral Tablet 500000U 4250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3805965NF-Probiotic Complex Oral Tablet 1250 PHARMACY 3805966NF-Colchicine Oral Tablet 0.6MG 20250 PHARMACY 3805967NF-Famotidine Oral Tablet 40MG 12250 PHARMACY 3805968NF-Isosorbide Mononitrate Tablet 10MG 1250 PHARMACY 3805969NF-Primidone Oral Tablet 50MG 1250 PHARMACY 3805974NF-busPIRone Oral Tablet 30MG 13250 PHARMACY 3805976NF-Propecia Tablet 1MG 12250 PHARMACY 3805977NF-Ozempic 0.25MG or 0.5MG Doses 2MG/1.5 1853250 PHARMACY 3805978NF-Cialis Tablet 10MG 250250 PHARMACY 3805980NF-Progesterone Oral Capsule 100MG 6250 PHARMACY 3805982NF-rOPINIRole Hydrochloride Tablet 3MG 7250 PHARMACY 3805983NF-Glucosamine/Chondroitin Cap 30-500-40 3250 PHARMACY 3805984NF-metFORMIN HCl Tablet 1000MG 4250 PHARMACY 3805986NF-Dyazide Capsule 7250 PHARMACY 3805987NF-Keflex Oral Capsule 250MG 9250 PHARMACY 3805988NF-Nadolol Oral Tablet 40MG 11250 PHARMACY 3805989NF-BELBUCA BUCCAL FILM 900MCG 49.13250 PHARMACY 3805990NF-Zebeta Tablet 5mg 11250 PHARMACY 3805991NF-Ortho Tri-Cyclen Lo Oral Kit 19250 PHARMACY 3805992Plasmalyte pH 7.4 88258 IV SOLUTIONS 3805993NF-Gleevec Tablet 100MG 337250 PHARMACY 3805994NF-Topamax Oral Capsule 15MG 20250 PHARMACY 3805995NF-Avapro Oral Tablet 300MG 27250 PHARMACY 3805996NF-Mirapex Oral Tablet 0.25MG 25250 PHARMACY 3805997NF-Niaspan Extended-Release Tablet 1000M 32250 PHARMACY 3805998NF-Nuvigil Oral Tablet 150MG 95250 PHARMACY 3805999NF-Doxycycline Oral Capsule 100MG 4250 PHARMACY 3806000NF-Esterified Estrogens-MethylTESTOSTERo 5250 PHARMACY 3806001NF-Simvastatin Oral Tablet 80MG 14250 PHARMACY 3806004NF-buPROPion HCl SR Oral 12 HR Tab ER 15 5250 PHARMACY 3806006NF-hydrOXYzine HCl Oral Tablet 10MG 1250 PHARMACY 3806007NF-Sotalol Oral Tablet 80MG 15250 PHARMACY 3806008Prednisone 20mg 4636 DRUGS/DETAIL CODE 3806009Belbuca 300mcg 66636 DRUGS/DETAIL CODE 3806010NF-Visine Tears Ophth Soln 0.2%-0.2%-0.1 1250 PHARMACY 3806011NF-Allergy Eye Drops Ophth Soln 0.025% 2250 PHARMACY 3806012NF-Lexapro Tablet 5MG 39250 PHARMACY 3806013NF-RizatriptanBenzoate Disintegrat Tab 5 99250 PHARMACY 3806014NF-Minocycline HCl Tablet 100MG 18250 PHARMACY 3806015NF-Doxepin HCl Oral Capsule 50MG 3250 PHARMACY 3806018NF-Simvastatin Oral Tablet 10MG 8250 PHARMACY 3806021NF-ZyrTEC-D Tab ER 5MG-120MG 3250 PHARMACY 3806023NF-Benicar Oral Tablet 40MG 36250 PHARMACY 3806024NF-dilTIAZem HCl 24 Hr Cap ER 360MG 7250 PHARMACY 3806027NF-dilTIAZem HCl Oral 24HR Cap ER 420MG 7250 PHARMACY 3806028NF-Buprenorphine HCl SL Tablet 8MG 25250 PHARMACY 3806029NF-Paxil Oral Tablet 30MG 13250 PHARMACY 3806032NF-Trulance Oral Tablet 3MG 49250 PHARMACY 3806033NF-CeleBREX Oral Capsule 200MG 45250 PHARMACY 3806036NF-Hydroxyurea Capsule 500MG 3250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806038NF-SEROquel Oral Tablet 400MG 69250 PHARMACY 3806040NF-SEROQUEL XR TAB ER 400MG 90.03250 PHARMACY 3806042NF-Baclofen Intrathecal Solution 0.5MG/1 34250 PHARMACY 3806043NF-oxyMORphone Hydrochloride Tab ER 7.5M 10250 PHARMACY 3806045NF-Prempro Oral Tablet 0.3MG-1.5MG 24250 PHARMACY 3806048NF-Estrace Vaginal Cream 0.1MG/1GM 3250 PHARMACY 3806049NF-PARoxetine Oral Tablet 40MG 8250 PHARMACY 3806050NF-Domperidone Powder 256250 PHARMACY 3806051NF-olmesartan medoxomil-hydroCHLOROthiaz 18250 PHARMACY 3806052NF-Omeprazole Oral Capsule DR 10MG 11250 PHARMACY 3806053NF-rOPINIRole Hydrochloride Tablet 0.25M 1250 PHARMACY 3806054NF-testosterone Topical Gel 10MG/0.5GM 20250 PHARMACY 3806056NF-Zegerid Oral Capsule 20MG-1100MG 396250 PHARMACY 3806061NF-Calcitriol Liq Cap 0.25MCG 3250 PHARMACY 3806063NF-TEGretol-XR Oral Tab ER 400MG 19250 PHARMACY 3806064NF-Vyzulta Ophthalmic Solution 0.024% 274250 PHARMACY 3806065NF-Sildenafil Oral Tablet 100MG 199250 PHARMACY 3806069NF-amLODIPine and Benazepril Cap 10MG-40 14250 PHARMACY 3806070NF-Amethyst Oral Tablet 90MCG-20MCG 6250 PHARMACY 3806073NF-Requip XL Oral Tab ER 4MG 35250 PHARMACY 3806074NF-SEROquel Tablet 200MG 45250 PHARMACY 3806075NF-Benztropine Mesylate Oral Tablet 0.5M 1250 PHARMACY 3806076NF-Effexor-XR Capsule 150MG 55250 PHARMACY 3806077NF-Saphris Sublingual Tablet 2.5MG 72250 PHARMACY 3806078NF-Aciphex Enteric Coated Tablet 20MG 62250 PHARMACY 3806079NF-REQUIP XL ORAL TAB ER 2MG 10.99250 PHARMACY 3806080Ceftazidime 2gm IVPB 125636 DRUGS/DETAIL CODE 3806081NF-Levoxyl Oral Tablet 50MCG 1250 PHARMACY 3806083NF-Alphagan P Ophth Solution 0.15% 122250 PHARMACY 3806084NF-dilTIAZem CD 24 Hr Cap 120MG 6250 PHARMACY 3806085NF-Dorzolamide Hydrochloride Ophth Soln 20250 PHARMACY 3806086NF-BRIMONIDINE TARTRATE OPHTH SOLN 0.2% 10.88250 PHARMACY 3806087NF-Pulmicort Flexhaler Inh/Neb 180MCG/1A 850250 PHARMACY 3806088NF-rOPINIRole Hydrochloride Tablet 4MG 7250 PHARMACY 3806090NF-Bevespi Aerosphere Inh 4.8MCG-9MCG/1A 122250 PHARMACY 3806092NF-Estrace Oral Tablet 2MG 3250 PHARMACY 3806093NF-medroxyPROGESTERone Acetate Tablet 5M 1250 PHARMACY 3806094NF-Refresh Tears Ophth Solution 0.5% 1250 PHARMACY 3806095NF-raNITIdine Oral Tablet 300MG 8250 PHARMACY 3806096NF-Azelastine HCl Nasal Spray 205.5MCG/1 6250 PHARMACY 3806098NF-Abilify Tablet 10MG 107250 PHARMACY 3806099NF-fluvoxaMINE Maleate Tablet 100MG 7250 PHARMACY 3806101NF-Etodolac Tablet 500MG 4250 PHARMACY 3806102NF-Hysingla ER Oral Tab ER 20MG 34250 PHARMACY 3806103NF-prednisoLONE Na Phos ODT 10MG 43250 PHARMACY 3806105Jardiance 25mg 57636 DRUGS/DETAIL CODE 3806106NF-Lisinopril Oral Tablet 30MG 4250 PHARMACY 3806107Vitamin B-12 1000mcg 4636 DRUGS/DETAIL CODE 3806109Vitamin B-12 100mcg 4636 DRUGS/DETAIL CODE 3806110NF-Provera Oral Tablet 5MG 13250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806111NF-Lidocaine Topical Cream 4% 6250 PHARMACY 3806116NF-Osphena Oral Tablet 60MG 25250 PHARMACY 3806117NF-Mirapex Oral Tablet 1MG 26250 PHARMACY 3806118NF-Donepezil Hydrochloride Oral Tablet 5 25250 PHARMACY 3806119NF-Memantine HCl Oral Tablet 10MG 18250 PHARMACY 3806120NF-MACRODANTIN CAPSULE 50MG 4.59250 PHARMACY 3806121NF-Pramipexole Dihydrochloride Tab 0.125 9250 PHARMACY 3806122NF-Carbinoxamine Maleate Oral Tablet 4MG 2250 PHARMACY 3806123NF-Cyanocobalamin Injection 1000MCG/ML 12250 PHARMACY 3806124NF-Ramipril Oral Capsule 1.25MG 4250 PHARMACY 3806125NF-Terazosin HCl Capsule 10MG 4250 PHARMACY 3806127NF-Valtrex Tablet 1GM 77250 PHARMACY 3806128NF-ESTRADIOL ORAL TABLET 1MG 1.12250 PHARMACY 3806129NF-Keppra XR Oral Tablet ER 500MG 25250 PHARMACY 3806131NF-SEROquel Tablet 300MG 59250 PHARMACY 3806132NF-Enbrel Subcutaneous Solution 50MG/1ML 4751250 PHARMACY 3806133NF-SEROquel Oral Tablet 50MG 22250 PHARMACY 3806134NF-Memantine HCl Oral Tablet 10MG 18250 PHARMACY 3806135NF-FIASP INJ SOLN 100U/1ML 104.17250 PHARMACY 3806136NF-Estradiol TD Patch ER 0.06MG/24Hrs 69250 PHARMACY 3806137NF-Testosterone Topical Solution 30MG/1. 10250 PHARMACY 3806138NF-Carvedilol Oral Tablet 6.25MG 6250 PHARMACY 3806139NF-Levothyroxine Oral Tablet 50MCG 1250 PHARMACY 3806140NF-Potassium Chloride Oral Tab ER 20MEQ 1250 PHARMACY 3806141NF-lamoTRIgine Oral Tablet 200MG 18250 PHARMACY 3806142NF-amLODIPine and Benazepril Cap 5MG-10M 8250 PHARMACY 3806143NF-Propranolol Hydrochloride Tablet 40MG 2250 PHARMACY 3806144NF-Chantix Oral Tablet 0.5MG 27250 PHARMACY 3806145NF-Ziac Tablet 5MG-6.25MG 4250 PHARMACY 3806146NF-hydrALAZINE HCl Tablet 100MG 3250 PHARMACY 3806147NF-Aldactone Oral Tablet 50MG 1250 PHARMACY 3806148NF-Nature-Throid Oral Tablet 130MG 2250 PHARMACY 3806149NF-Digox Oral Tablet 0.125MG 4250 PHARMACY 3806150NF-NexIUM Oral Packet 5MG/1Pkt 32250 PHARMACY 3806151NF-NATURE-THROID ORAL TABLET 65MG 1.05250 PHARMACY 3806158NF-Enalapril Oral Tablet 20MG 6250 PHARMACY 3806161NF-Hyoscyamine Sulfate Oral Tablet 0.125 2250 PHARMACY 3806162NF-amLODIPine Besylate Oral Tablet 10MG 7250 PHARMACY 3806163NF-metFORMIN HCl Tablet 500MG 2250 PHARMACY 3806164NF-Simvastatin Oral Tablet 80MG 14250 PHARMACY 3806165NF-tetrabenazine Oral Tablet 25MG 472250 PHARMACY 3806166NF-Phenazopyridine Oral Tablet 200MG 2250 PHARMACY 3806167NF-Xtandi Oral Liquid Filled Capsule 40M 346250 PHARMACY 3806169NF-Fluticasone Propionate Oint 0.005% 3250 PHARMACY 3806170NF-Levothyroxine Sodium Oral Tablet 175M 2250 PHARMACY 3806176NF-Acyclovir Oral Tablet 800MG 11250 PHARMACY 3806178NF-Pred Forte Ophth Suspension 1% 4250 PHARMACY 3806179NF-metroNIDAZOLE Topical Gel 0.75% 10250 PHARMACY 3806182NF-Vitamin D Oral Capsule 50000IU 4250 PHARMACY 3806183NF-FLUoxetine HCl Oral Capsule 20MG 7250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806184NF-Fosinopril Sodium Oral Tablet 20MG 3250 PHARMACY 3806185NF-Onglyza Oral Tablet 5MG 35250 PHARMACY 3806186NF-RisperDAL Tablet 2MG 68250 PHARMACY 3806188NF-Nortriptyline Oral Capsule 10MG 1250 PHARMACY 3806189NF-Atomoxetine Oral Capsule 40MG 46250 PHARMACY 3806192NF-Premarin Oral Tablet 0.3MG 20250 PHARMACY 3806193NF-Xyzal Allergy 24HR Oral Tablet 5MG 1250 PHARMACY 3806197NF-Methenamine Hippurate Oral Tablet 1GM 6250 PHARMACY 3806198NF-Fenofibrate Oral Tablet 54MG 2250 PHARMACY 3806199NF-glipiZIDE Oral Tab ER 2.5MG 1250 PHARMACY 3806200NF-Lovastatin Oral Tablet 20MG 8250 PHARMACY 3806202NF-Nitrofurantoin Macrocrystals Cap 50MG 6250 PHARMACY 3806203NF-Terbinafine Hydrochloride Oral Tab 25 38250 PHARMACY 3806204NF-PARoxetine HCl Oral Tablet 30MG 8250 PHARMACY 3806205NF-Starlix Tablet 60MG 3250 PHARMACY 3806207NF-Brimonidine Tartrate Ophth Solution 0 19250 PHARMACY 3806208NF-Febuxostat Oral Tablet 40MG 35250 PHARMACY 3806209Hiprex 1gm 5636 DRUGS/DETAIL CODE 3806210NF-Doxycycline Oral Capsule 150MG 73250 PHARMACY 3806211NF-busPIRone Oral Tablet 5MG 2250 PHARMACY 3806214NF-Cartia XT Oral 24 Hr Cap ER 120MG 3250 PHARMACY 3806217NF-Refresh Optive Ophthalmic Soln 0.5%-0 1250 PHARMACY 3806220NF-NICOTINE POLACRILEX GUM 4MG 1.35250 PHARMACY 3806221NF-Torsemide Oral Tablet 10MG 2250 PHARMACY 3806223NF-Tacrolimus Oral Capsule 1MG 13250 PHARMACY 3806224NF-Polymyxin B/Trimethoprim Ophth Soluti 3250 PHARMACY 3806226NF-Clobetasol Propionate Solution 0.05% 12250 PHARMACY 3806227NF-Doxycycline Hyclate Oral Capsule 100M 4250 PHARMACY 3806229NF-THYROID TAB 90MG 4.32250 PHARMACY 3806231NF-Primidone Oral Tablet 50MG 1250 PHARMACY 3806233NF-Simvastatin Oral Tablet 80MG 14250 PHARMACY 3806235NF-Enalapril/HCTZ 10MG-25MG Tablet 3250 PHARMACY 3806238NF-Premarin Tablet 1.25MG 20250 PHARMACY 3806239NF-Synthroid Oral Tablet 200MCG 4250 PHARMACY 3806242NF-Thyroid Tablet 65MG 1250 PHARMACY 3806245NF-Prolia Subcutaneous Solution 60MG/1ML 4388250 PHARMACY 3806246NF-Prazosin HCl Oral Capsule 5MG 3250 PHARMACY 3806247NF-Symproic Oral Tablet 0.2MG 43250 PHARMACY 3806249NF-olmesartan medoxomil-hydroCHLOROthiaz 28250 PHARMACY 3806251NF-Clorazepate Dipotassium Tablet 7.5MG 4250 PHARMACY 3806252NF-Lovastatin Oral Tablet 40MG 15250 PHARMACY 3806254NF-Urocit-K Oral Tab ER 15MEQ 13250 PHARMACY 3806255NF-Envarsus XR Tab Extended Release 0.75 14250 PHARMACY 3806256NF-Combivent Inh Aer Pwd 103MCG-18MCG/1 68250 PHARMACY 3806258NF-rOPINIRole Hydrochloride Oral Tablet 7250 PHARMACY 3806259NF-Trokendi XR Oral Capsule ER 100MG 88250 PHARMACY 3806261NF-Triamcinolone Acetonide Ointment 0.5% 2250 PHARMACY 3806262NF-Vasotec Oral Tablet 5MG 57250 PHARMACY 3806263NF-Minocycline HCl Oral Tab ER 65MG 138250 PHARMACY 3806264NF-Rexulti Oral Tablet 2MG 139250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806265NF-CeleBREX Oral Capsule 100MG 27250 PHARMACY 3806266NF-Enalapril Oral Tablet 20MG 6250 PHARMACY 3806267NF-NIFEdipine Oral Tab ER 60MG 7250 PHARMACY 3806268NF-Toprol XL Tablet 200MG 10250 PHARMACY 3806269NF-glipiZIDE XL Oral Tablet 10MG 2250 PHARMACY 3806270NF-PARoxetine Hydrochloride Tab ER 37.5M 17250 PHARMACY 3806271NF-Sildenafil Oral Tablet 100MG 199250 PHARMACY 3806272NF-tadalafil Oral Tablet 5MG 38250 PHARMACY 3806275NF-Carvedilol Oral Tablet 25MG 5250 PHARMACY 3806277NF-Atenolol Oral Tablet 100MG 4250 PHARMACY 3806279NF-Lovastatin Oral Tablet 10MG 4250 PHARMACY 3806280NF-Mucinex DM Oral Tab ER 60MG-1200MG 2250 PHARMACY 3806283NF-Cortef Oral Tablet 5MG 3250 PHARMACY 3806284NF-methIMAzole Tablet 5MG 1250 PHARMACY 3806287NF-Co Q-10 AvPak Oral Capsule 30MG 1250 PHARMACY 3806288NF-Prazosin Oral Capsule 2MG 4250 PHARMACY 3806291NF-HCTZ-Metoprolol Tablet 25MG-100MG 6250 PHARMACY 3806293NF-Desloratadine Oral Tablet 5MG 15250 PHARMACY 3806294NF-Claritin-D 12HR Oral Tab ER 5MG-120MG 2250 PHARMACY 3806295NF-Desmopressin Oral Tablet 0.2MG 22250 PHARMACY 3806298NF-OLANZapine Oral Tablet 10MG 55250 PHARMACY 3806299NF-Vyvanse Oral Capsule 70MG 36250 PHARMACY 3806302NF-Alprostadil Inj Soln 0.5MG/ML 390250 PHARMACY 3806305NF-Lisinopril Oral Tablet 20MG 3250 PHARMACY 3806306NF-Dorzolamide Hydrochloride and Timolol 36250 PHARMACY 3806307NF-Lubricant Eye Drops Ophthalmic Soln 0 1250 PHARMACY 3806308Glyxambi 25/5 62636 DRUGS/DETAIL CODE 3806309Primidone 50mg 4636 DRUGS/DETAIL CODE 3806311NF-Lisinopril Tablet 5mg 2250 PHARMACY 3806313NF-LISINOPRIL ORAL TABLET 5MG 2.9250 PHARMACY 3806314NF-QUEtiapine Fumarate Oral Tablet 200MG 38250 PHARMACY 3806315NF-Arnuity Ellipta Inh Pwd 100MCG/1ACT 20250 PHARMACY 3806316NF-Candesartan Cilexetil Oral Tablet 32M 12250 PHARMACY 3806317Zosyn 4.5gm IVPB 84.5636 DRUGS/DETAIL CODE 3806318NF-Losartan Potassium Oral Tablet 100MG 9250 PHARMACY 3806319NF-Pantoprazole Sodium Oral Tab EC 20MG 1250 PHARMACY 3806320NF-Triamcinolone Acetonide Cream 0.1% 1250 PHARMACY 3806321NF-Indapamide Tablet 1.25MG 2250 PHARMACY 3806322NF-Metoprolol Succinate Tab ER 200MG 8250 PHARMACY 3806323NF-Xifaxan Oral Tablet 550MG 142250 PHARMACY 3806324NF-Imitrex Spray 20MG 293250 PHARMACY 3806325NF-Metoprolol Succinate ER Tab ER 100MG 4250 PHARMACY 3806326NF-Alendronate Sodium Oral Tablet 70MG 61250 PHARMACY 3806329NF-XIFAXAN ORAL TABLET 550MG 142.11250 PHARMACY 3806330NF-NP Thyroid Oral Tablet 30MG 2250 PHARMACY 3806331NF-Zestoretic Oral Tablet 20MG-25MG 47250 PHARMACY 3806332NF-Ipratropium Brom Nasal Spray 0.03% 16250 PHARMACY 3806333NF-Mucinex DM Oral Tab ER 60MG-1200MG 2250 PHARMACY 3806334NF-Pilocarpine Oral Tablet 5MG 7250 PHARMACY 3806335NF-Liothyronine Sodium Oral Tab 25MCG 3250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806337NF-sulfaSALAzine Enteric-Coated Tab 500M 1250 PHARMACY 3806341NF-dilTIAZem Oral Cap ER 120MG 10250 PHARMACY 3806342NF-Lansoprazole Oral Cap DR 30MG 17250 PHARMACY 3806344NF-Trandolapril Oral Tablet 2MG 3250 PHARMACY 3806346NF-Terazosin HCl Capsule 10MG 4250 PHARMACY 3806349NF-Pristiq Extended-Release Tablet 100MG 48250 PHARMACY 3806350NF-Prasugrel Hydrochloride Oral Tablet 1 49250 PHARMACY 3806351NF-valsartan Oral Tablet 80MG 14250 PHARMACY 3806352NF-metFORMIN HCl Oral Tab ER 750MG 4250 PHARMACY 3806354NF-Temazepam Capsule 7.5MG 29250 PHARMACY 3806355NF-Terazosin HCl Capsule 2MG 4250 PHARMACY 3806357NF-Nitrofurantoin Oral Capsule 100MG 9250 PHARMACY 3806359NF-Fluconazole Tablet 200MG 42250 PHARMACY 3806363NF-metFORMIN Hydrochloride Tab ER 750MG 3250 PHARMACY 3806364NF-SARAFEM ORAL TABLET 10MG 75.18250 PHARMACY 3806366NF-Abilify Tablet 20MG 151250 PHARMACY 3806367NF-Amitriptyline Oral Tablet 10MG 2250 PHARMACY 3806368NF-Brimonidine Tartrate Ophth Soln 0.15% 105250 PHARMACY 3806370NF-Pindolol Tablet 5MG 3250 PHARMACY 3806371NF-prednisoLONE Acetate Ophth Suspension 33250 PHARMACY 3806372NF-Fosinopril Sodium Oral Tablet 10MG 3250 PHARMACY 3806373NF-Doxycycline Oral Tablet 100MG 14250 PHARMACY 3806376NF-METOPROLOL TARTRATE ORAL TABLET 100MG 3.2250 PHARMACY 3806377NF-LEVOTHYROXINE SODIUM TAB 75MCG 1.93250 PHARMACY 3806380Opana IR (Oxymorphone) 5 mg 5250 PHARMACY 3806381NF-Simvastatin Oral Tablet 10MG 8250 PHARMACY 3806382NF-Glucovance Tablet 4250 PHARMACY 3806383NF-Culturelle Digestive Health Oral Cap 1250 PHARMACY 3806385NF-risperiDONE Oral Tablet 2MG 11250 PHARMACY 3806386NF-Wellbutrin SR 12 Hr Tab ER 200MG 49250 PHARMACY 3806388NF-glyBURIDE Micronized/metFORMIN HCl Ta 2250 PHARMACY 3806390NF-Elmiron Oral Capsule 100MG 33250 PHARMACY 3806392NF-Mesalamine Oral Tablet DR 1.2GM 30250 PHARMACY 3806394NF-Prazosin HCl Oral Capsule 5MG 2250 PHARMACY 3806396NF-Sprix Nasal Spray 15.75MG/1ACT 678250 PHARMACY 3806397NF-amLODIPine Besylate Oral Tablet 10MG 7250 PHARMACY 3806398NF-Lisinopril-HCTZ Oral Tablet 20MG-25MG 1250 PHARMACY 3806399NF-Lovastatin Tablet 40MG 12250 PHARMACY 3806400NF-Candesartan Cilexetil Oral Tablet 32M 13250 PHARMACY 3806401NF-ZyrTEC-D Tab ER 5MG-120MG 2250 PHARMACY 3806403NF-Systane Ultra Ophthalmic Soln 0.4%-0. 40250 PHARMACY 3806405NF-Enalapril Oral Tablet 5MG 4250 PHARMACY 3806406NF-Silodosin Oral Capsule 8MG 26250 PHARMACY 3806408NF-HydrOXYzine HCl Oral Tablet 10MG 1250 PHARMACY 3806410NF-Paliperidone Oral Tablet ER 9MG 137250 PHARMACY 3806411NF-QUEtiapine Fumarate Oral Tablet 400MG 59250 PHARMACY 3806412NF-PARoxetine mesylate Oral Capsule 7.5M 19250 PHARMACY 3806413NF-MIRTAZAPINE ORAL TABLET 30MG 8.39250 PHARMACY 3806414NF-Lunesta Tablet 2MG 56250 PHARMACY 3806415NF-amLODIPine Besylate Oral Tablet 10MG 7250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806416NF-HydrOXYzine HCl Oral Tablet 50MG 3250 PHARMACY 3806417NF-Paliperidone Oral Tablet ER 9MG 137250 PHARMACY 3806418NF-dofetilide Oral Capsule 125MCG 25250 PHARMACY 3806419NF-SILODOSIN CAP 8MG 28.04250 PHARMACY 3806421NF-Estradiol Tablet 2MG 2250 PHARMACY 3806424NF-Minocycline Oral Capsule 50MG 4250 PHARMACY 3806425NF-Myrbetriq Oral Tablet 50MG 46250 PHARMACY 3806426NF-Pantoprazole Sodium Tab EC 20MG 12250 PHARMACY 3806427NF-tacrolimus Topical Ointment 0.1% 26250 PHARMACY 3806429NF-Calcium 600 + D3 AvPak Tab 600MG-800I 2250 PHARMACY 3806431NF-Amitriptyline Oral Tablet 10MG 1250 PHARMACY 3806433NF-DULoxetine HCl Oral Cap DR 40MG 23250 PHARMACY 3806435NF-Nateglinide Oral Tablet 120MG 5250 PHARMACY 3806436NF-Welchol Oral Tablet 625MG 13250 PHARMACY 3806438NF-Avalide Oral Tablet 150MG-12.5MG 26250 PHARMACY 3806439NF-metFORMIN Hydrochloride Tab ER 750MG 3250 PHARMACY 3806440NF-amLODIPine besylate-valsartan 10MG-16 18250 PHARMACY 3806441NF-Telmisartan-HCTZ Oral Tablet 80MG-12. 16250 PHARMACY 3806442NF-amLODIPine Besylate AvPak Tablet 10MG 13250 PHARMACY 3806444NF-APAP/Codeine Phosphate Tab 300MG-60MG 3250 PHARMACY 3806445NF-Incruse Ellipta Inh Pwd 62.5MCG/1ACT 36250 PHARMACY 3806446NF-Sertraline Oral Tablet 100MG 8250 PHARMACY 3806447NF-FLUoxetine HCl Oral Capsule 20MG 7250 PHARMACY 3806449NF-FLUOXETINE HCL CAP 10MG 14.87250 PHARMACY 3806450NF-Fluorouracil Topical Cream 5% 19250 PHARMACY 3806451NF-Ipratropium Bromide Nasal Spray 0.06% 19250 PHARMACY 3806452NF-Losartan/Hctz Oral Tablet 100MG-12.5M 10250 PHARMACY 3806453NF-Doxepin HCl Topical application Cream 48250 PHARMACY 3806454NF-Fluocinonide Topical Cream 0.1% 1250 PHARMACY 3806455NF-Ipratropium Bromide Nasal Spray 0.03% 11250 PHARMACY 3806456NF-Lidocaine Topical Ointment 5% 3250 PHARMACY 3806459NF-Olmesartan Medoxomil Oral Tablet 5MG 15250 PHARMACY 3806461NF-Synjardy Oral Tablet 12.5MG-1000MG 29250 PHARMACY 3806462NF-tadalafil Oral Tablet 5MG 36250 PHARMACY 3806463NF-Pentasa Capsule Extended-Release 500M 21250 PHARMACY 3806464NF-dilTIAZem Oral Cap ER 240MG 5250 PHARMACY 3806465NF-Minoxidil Tablet 10MG 3250 PHARMACY 3806466NF-Invokamet Oral Tablet 150MG-500MG 29250 PHARMACY 3806467NF-armodafinil Oral Tablet 150MG 65250 PHARMACY 3806469NF-Estrace Oral Tablet 1MG 19250 PHARMACY 3806470NF-Ketotifen Fumarate Ophth Solution 0.0 7250 PHARMACY 3806471NF-valsartan Oral Tablet 80MG 13250 PHARMACY 3806473NF-TraZODone Hydrochloride Tablet 150MG 7250 PHARMACY 3806474NF-Rosuvastatin Calcium Oral Tablet 5MG 26250 PHARMACY 3806475NF-CARVEDILOL ORAL TABLET 25MG 3.35250 PHARMACY 3806476NF-IRBESARTAN AVPAK TAB 300MG 12.1250 PHARMACY 3806477NF-SOLIFENACIN SUCCINATE ORAL TABLET 10M 43.95250 PHARMACY 3806478NF-Nifedical XL Tablet 30MG 4250 PHARMACY 3806479NF-Mirtazapine Tablet 7.5MG 7250 PHARMACY 3806480NF-amLODIPine-hctz-olmesartan Tab 29250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806481NF-Venlafaxine Hydrochloride Tablet 75MG 6250 PHARMACY 3806482NF-Doxazosin Tablet 1MG 4250 PHARMACY 3806483NF-Macrobid Capsule 100MG 12250 PHARMACY 3806484NF-Nitrofurantoin Oral Capsule 100MG 9250 PHARMACY 3806487NF-amLODIPine and Benazepril Cap 2.5MG-1 7250 PHARMACY 3806488NF-Candesartan Cilexetil Oral Tablet 16M 9250 PHARMACY 3806490NF-busPIRone Oral Tablet 5MG 2250 PHARMACY 3806491NF-Carvedilol Oral Tablet 25MG 6250 PHARMACY 3806492NF-Enalapril Maleate Oral Tablet 5MG 5250 PHARMACY 3806496NF-BENAZEPRIL HCL ORAL TABLET 10MG 3.63250 PHARMACY 3806497NF-LYRICA CR EXTENDED RELEASE TABLET 165 48.27250 PHARMACY 3806498NF-Bisoprolol/HCTZ 2.5MG-6.25MG Tablet 4250 PHARMACY 3806500NF-ATORVASTATIN CALCIUM ORAL TAB 40MG 17.3250 PHARMACY 3806501NF-LEVOTHYROXINE ORAL TABLET 50MCG 1.08250 PHARMACY 3806502NF-PEPTO-BISMOL ORAL TABLET 262MG 0.52250 PHARMACY 3806504NF-Venlafaxine Hydrochloride Tablet 225M 47250 PHARMACY 3806507NF-Simbrinza Ophthalmic Suspension 0.2%- 73250 PHARMACY 3806510NF-Imitrex Oral Tablet 25MG 57250 PHARMACY 3806511NF-Neupro TD Patch ER 6MG/24HR 80250 PHARMACY 3806512NF-Aricept Tablet 5MG 60250 PHARMACY 3806513NF-Digox Oral Tablet 0.125MG 3250 PHARMACY 3806514NF-terbinafine Oral Tablet 250MG 40250 PHARMACY 3806515NF-Zohydro ER Oral Capsule ER 15MG 25250 PHARMACY 3806516NF-Trelegy Ellipta Inhalation Powder 32250 PHARMACY 3806517NF-Exforge Oral Tablet 5MG-160MG 31250 PHARMACY 3806519NF-Travatan Z Ophthalmic Solution 0.004% 264250 PHARMACY 3806522NF-QUEtiapine Fumarate Oral Tablet 50MG 19250 PHARMACY 3806524NF-Bystolic Oral Tablet 10MG 17250 PHARMACY 3806525NF-metOLazone Oral Tablet 5MG 12250 PHARMACY 3806526NF-Mirtazapine Tablet 15MG 8250 PHARMACY 3806527NF-Lisinopril Oral Tablet 5MG 3250 PHARMACY 3806528NF-Synthroid Oral Tablet 50MCG 1250 PHARMACY 3806529NF-Wellbutrin SR 12 Hr Tab ER 150MG 8250 PHARMACY 3806531NF-Pravachol Tablet 40MG 20250 PHARMACY 3806532NF-metFORMIN Hydrochloride Tablet 500MG 3250 PHARMACY 3806533NF-Triazolam Tablet 0.25MG 11250 PHARMACY 3806534NF-Olopatadine HCl Nasal Spray 0.6% 26250 PHARMACY 3806536NF-RABEPRAZOLE SODIUM ORAL TAB EC 20MG 36.45250 PHARMACY 3806539NF-Vyvanse Oral Capsule 50MG 36250 PHARMACY 3806540NF-Dilt-XR 24 Hour Oral Capsule ER 120mg 3250 PHARMACY 3806541NF-amLODIPine Besylate Oral Tablet 2.5MG 5250 PHARMACY 3806542NF-Solifenacin Succinate Oral Tablet 10M 43250 PHARMACY 3806545NF-NP THYROID ORAL TABLET 60MG 2.45250 PHARMACY 3806546NF-THYROID TAB 120MG 3.71250 PHARMACY 3806548NF-Telmisartan-HCTZ Oral Tablet 40MG-12. 16250 PHARMACY 3806549NF-HumaLOG Injection 100U/ML 98250 PHARMACY 3806550NF-amLODIPine besylate-valsartan 10MG-32 23250 PHARMACY 3806551NF-Klor-Con M20 Tablet 20MEQ 1250 PHARMACY 3806552NF-Sotalol HCl Tablet 160MG 12250 PHARMACY 3806554NF-Oxazepam Capsule 15MG 3250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806555NF-amLODIPine and Benazepril Cap 5MG-40M 12250 PHARMACY 3806557NF-rOPINIRole Oral Tab ER 6MG 24250 PHARMACY 3806558NF-Spironolactone-HCTZ Tablet 25MG-25MG 3250 PHARMACY 3806559NF-VESIcare Oral Tablet 10MG 46250 PHARMACY 3806563NF-Lyrica Oral Capsule 50MG 20250 PHARMACY 3806564NF-Midodrine HCl Oral Tablet 10MG 14250 PHARMACY 3806565NF-Morphine Sulfate IR Oral Tablet 30MG 5250 PHARMACY 3806566NF-Cozaar Oral Tablet 100MG 18250 PHARMACY 3806567NF-Clarinex-D 12HR Oral Tab ER 2.5MG-120 18250 PHARMACY 3806568NF-Pramipexole Dihydrochloride Tab 0.25M 9250 PHARMACY 3806569NF-Xeljanz XR Oral Tablet ER 11MG 537250 PHARMACY 3806572NF-Ximino Oral Cap ER 135MG 83250 PHARMACY 3806574NF-Soolantra Topical application Cream 1 45250 PHARMACY 3806575NF-Fexofenadine Hydrochloride Oral Tab 3 2250 PHARMACY 3806576NF-Lovastatin Oral Tablet 10MG 4250 PHARMACY 3806577NF-Oxybutynin Chloride Tab ER 10MG 9250 PHARMACY 3806578NF-Ciclopirox Topical Solution 8% 27250 PHARMACY 3806580NF-Latuda Oral Tablet 80MG 146250 PHARMACY 3806581NF-Savella Oral Tablet 100MG 22250 PHARMACY 3806582NF-Darifenacin HBr Oral Tablet ER 15MG 33250 PHARMACY 3806584NF-Flecainide Acetate Tablet 100MG 10250 PHARMACY 3806585NF-Rosuvastatin Calcium Oral Tablet 20MG 26250 PHARMACY 3806586NF-Carbidopa/Levodopa Tablet 25MG-250MG 3250 PHARMACY 3806587NF-FLUoxetine Oral Tablet 20MG 12250 PHARMACY 3806588NF-Fosinopril Sodium Tablet 20MG 3250 PHARMACY 3806589NF-RisperDAL Tablet 2MG 68250 PHARMACY 3806590NF-Acyclovir Oral Tablet 800MG 10250 PHARMACY 3806591NF-Tirosint Liquid Filled Capsule 25MCG 15250 PHARMACY 3806592NF-Estradiol Tablet 1MG 2250 PHARMACY 3806593NF-Olmesartan Medoxomil Oral Tablet 40MG 28250 PHARMACY 3806594NF-Synthroid Tablet 75MCG 1250 PHARMACY 3806595NF-Deplin 7.5 Oral Capsule 7.5MG-90.314M 20250 PHARMACY 3806596NF-Evoxac Oral Capsule 30MG 26250 PHARMACY 3806600NF-DEPAKOTE DELAYED-RELEASE TABLET 250M 5.75250 PHARMACY 3806601NF-Depakote Delayed-Release Tablet 250MG 12250 PHARMACY 3806602NF-ROPINIROLE HCL TAB 5MG 7.5250 PHARMACY 3806603NF-Aygestin Oral Tablet 5MG 5250 PHARMACY 3806604NF-Dyazide Capsule 7250 PHARMACY 3806606NF-Pepcid Complete Chewable Tab 1250 PHARMACY 3806608NF-Systane Complete Ophth Soln 0.6% 4250 PHARMACY 3806611NF-Asmanex HFA Inh Aer Powder 200MCG/1AC 62250 PHARMACY 3806612NF-Primatene Mist Inh Aer Liq 0.125MG/1A 7250 PHARMACY 3806613NF-olmesartan medoxomil-hydroCHLOROthiaz 20250 PHARMACY 3806615NF-Colestipol Hydrochloride Oral Tablet 3250 PHARMACY 3806616NF-Farxiga Oral Tablet 5MG 37250 PHARMACY 3806617NF-levETIRAcetam Oral Tablet 750MG 1250 PHARMACY 3806618NF-Simvastatin Oral Tablet 10MG 8250 PHARMACY 3806619NF-Namenda Tablet 10MG 26250 PHARMACY 3806620NF-Premarin Oral Tablet 0.625MG 20250 PHARMACY 3806621NF-Atenolol Oral Tablet 100MG 3250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806622NF-Biktarvy Oral Tab 50MG-200MG-25MG 370250 PHARMACY 3806624NF-Telmisartan-HCTZ Oral Tablet 80MG-25M 16250 PHARMACY 3806625NF-ALPRAZolam Oral Tablet 0.25MG 2250 PHARMACY 3806626NF-Bisoprolol/HCTZ 5MG-6.25MG Tablet 4250 PHARMACY 3806627NF-Kombiglyze XR Oral Extended Release T 35250 PHARMACY 3806628NF-Morphine Sulfate Tablet 30MG 4250 PHARMACY 3806629NF-Sildenafil Oral Tablet 20MG 60250 PHARMACY 3806630NF-Baclofen Oral Tablet 20MG 15250 PHARMACY 3806632NF-Zantac 300 Tablet 300MG 9250 PHARMACY 3806633NF-Coreg Tablet 3.125MG 9250 PHARMACY 3806635NF-Azelastine HCl Ophth Soln 0.05% 52250 PHARMACY 3806636NF-Clindamycin Oral Capsule 300MG 15250 PHARMACY 3806637NF-Uceris Oral Extended Release Tablet 9 215250 PHARMACY 3806638NF-Lisinopril Oral Tablet 2.5MG 1250 PHARMACY 3806639NF-Nuvigil Oral Tablet 250MG 95250 PHARMACY 3806640NF-Allegra-D 12 Hour Oral Tab ER 60MG-12 2250 PHARMACY 3806644NF-Abilify Tablet 15MG 107250 PHARMACY 3806645NF-Geodon Capsule 60MG 84250 PHARMACY 3806647NF-Introvale Oral Tablet 0.15MG-30MCG 5250 PHARMACY 3806649NF-Venlafaxine Hydrochloride Tablet 225M 47250 PHARMACY 3806651NF-Contrave Oral Tab ER 8MG-90MG 6250 PHARMACY 3806653NF-Fosamax Tablet 10MG 11250 PHARMACY 3806654NF-Hyzaar Oral Tablet 100MG-12.5MG 20250 PHARMACY 3806656NF-Cilostazole Oral Tablet 50MG 5250 PHARMACY 3806657NF-Kevzara Subcutaneous Soln 200MG/1.14M 5247250 PHARMACY 3806658NF-Fenofibrate Micro Oral Capsule 67MG 3250 PHARMACY 3806659NF-Ramipril Oral Capsule 10MG 6250 PHARMACY 3806660NF-Exforge Oral Tablet 5MG-320MG 40250 PHARMACY 3806661NF-Allegra-D 24HR Tablet ER 180MG-240MG 14250 PHARMACY 3806667NF-Pioglitazone Oral Tablet 30MG 32250 PHARMACY 3806668NF-Stiolto Respimat Inh 2.5-2.5MCG/1Act 357250 PHARMACY 3806669NF-BUPROPION HCL ORAL TAB ER 12HR 200MG 11.5250 PHARMACY 3806670NF-ROPINIROLE HCL TAB 0.25MG 7.52250 PHARMACY 3806671NF-Pravastatin Sodium Oral Tablet 40MG 7250 PHARMACY 3806672NF-Amiodarone HCl Tablet 100MG 22250 PHARMACY 3806673NF-Klor-Con 8 Oral Tab ER 8mEq 1250 PHARMACY 3806674NF-Quinapril Oral Tablet 40MG 3250 PHARMACY 3806675NF-Midodrine HCl Tablet 5MG 7250 PHARMACY 3806676NF-Refresh Optive Advanced Ophth Soln 1250 PHARMACY 3806678NF-Candesartan Cilexetil Oral Tablet 8MG 9250 PHARMACY 3806680NF-Inderal LA Oral Cap ER 80MG 75250 PHARMACY 3806681NF-Propranolol ER Oral Cap ER 80MG 11250 PHARMACY 3806684NF-Xultophy SubQ Solution 100U-3.6MG/ML 262250 PHARMACY 3806685NF-Gabapentin Oral Tablet 800MG 9250 PHARMACY 3806686NF-Lisinopril Tablet 20mg 3250 PHARMACY 3806687NF-BUSPIRONE HCL ORAL TABLET 15MG 5.97250 PHARMACY 3806691NF-Urocit-K Tablet 10MEQ 7250 PHARMACY 3806693NF-Rosuvastatin Calcium Oral Tablet 5MG 26250 PHARMACY 3806694NF-Amantadine HCl Oral Capsule 100MG 1250 PHARMACY 3806695NF-Azilect Oral Tablet 1MG 99250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806696NF-Sildenafil Tablet 25MG 199250 PHARMACY 3806700NF-QUEtiapine Fumarate Oral Tablet 300MG 50250 PHARMACY 3806706NF-SERTRALINE HCL ORAL TABLET 100MG 8.54250 PHARMACY 3806707NF-TOPIRAMATE ORAL TABLET 50MG 14.82250 PHARMACY 3806708NF-Atenolol/Chlorthalidone Tablet 50MG-2 5250 PHARMACY 3806709NF-Cimetidine Tablet 400MG 7250 PHARMACY 3806711NF-Levothyroxine Sodium Oral Tablet 175M 2250 PHARMACY 3806712NF-Zomig Nasal Spray 2.5MG 291250 PHARMACY 3806714NF-amLODIPine-valsartan Tab 5MG-160MG 16250 PHARMACY 3806715NF-Aspercreme Topical Patch ER 4% 4250 PHARMACY 3806717NF-Carbidopa, Levodopa and Entacapone Ta 11250 PHARMACY 3806718CARBIDOPA/LEVODOPA/ENTACAPONE 50/200/200 5250 PHARMACY 3806719NF-Verapamil HCl Tablet 80MG 1250 PHARMACY 3806720NF-amLODIPine-valsartan Tab 5MG-160MG 4250 PHARMACY 3806721NF-Cimetidine Tablet 200MG 4250 PHARMACY 3806722NF-Flovent HFA Inh Oral/Neb 0.044MG/1Act 65250 PHARMACY 3806723NF-amLODIPine besylate-olmesartan medoxo 23250 PHARMACY 3806724NF-Leflunomide Oral Tablet 20MG 49250 PHARMACY 3806725NF-Ondansetron Oral Disintegrating Tab 8 111250 PHARMACY 3806731NF-Travatan Z Ophthalmic Solution 0.004% 279250 PHARMACY 3806732NF-NOVOLIN N INJECTION 100U/ML 49.57250 PHARMACY 3806733NF-NOVOLIN R INJECTION 100U/ML 49.57250 PHARMACY 3806734NF-Albuterol Oral Tablet 4MG 17250 PHARMACY 3806739NF-Citalopram Oral Tablet 20MG 7250 PHARMACY 3806741NF-Metoprolol Tartrate Tablet 100MG 2250 PHARMACY 3806742NF-Omeprazole Oral Tablet DR 20MG 1250 PHARMACY 3806743NF-valsartan Oral Tablet 320MG 18250 PHARMACY 3806745NF-Naproxen Enteric Coated Tablet 500MG 3250 PHARMACY 3806750NF-Exforge HCT Oral Tablet 10MG-320MG-25 45250 PHARMACY 3806751NF-Propranolol Hydrochloride Tablet 40MG 2250 PHARMACY 3806754NF-LOSARTAN POTASSIUM AVPAK TAB 100MG 6.47250 PHARMACY 3806755NF-Pepcid Oral Tablet 40MG 67250 PHARMACY 3806757 NF-LEVOTHYROXINE SODIUM ORAL TABLET 75MC 2.11 250 PHARMACY 3806758NF-LISINOPRIL ORAL TABLET 5MG 1.41250 PHARMACY 3806759NF-POTASSIUM CHLORIDE ORAL TAB ER 20MEQ 4.18250 PHARMACY 3806760NF-AMLODIPINE BESYLATE ORAL TABLET 10MG 8.52250 PHARMACY 3806761NF-BUPROPION HCL 24 HR TAB ER 300MG 18.89250 PHARMACY 3806762NF-ROPINIROLE HCL TAB 4MG 7.8250 PHARMACY 3806763NF-Sertraline Oral Tablet 25MG 8250 PHARMACY 3806764NF-metOLazone Oral Tablet 10MG 5250 PHARMACY 3806765NF-Cartia XT Oral 24 Hr Cap ER 300MG 7250 PHARMACY 3806766NF-Synjardy XR Oral Tab ER 12.5MG-1000MG 31250 PHARMACY 3806767NF-Estarylla Oral Tablet 3250 PHARMACY 3806768Metolazone 5mg 33250 PHARMACY 3806774NF-Descovy Oral Tablet 200MG-25MG 221250 PHARMACY 3806776NF-Isosorbide Mononitrate Tablet 60MG 1250 PHARMACY 3806778NF-Pramipexole Dihydrochloride Tab 1.5MG 9250 PHARMACY 3806779NF-Sudafed 12 Hour Oral Tablet 120MG 1250 PHARMACY 3806780NF-risperiDONE Oral Tablet 2MG 7250 PHARMACY 3806781NF-Lovastatin Oral Tablet 20MG 6250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806782NF-Rosuvastatin Calcium Oral Tablet 5MG 4250 PHARMACY 3806784NF-topiramate Capsule Extended Release 5 36250 PHARMACY 3806785NF-Bystolic Oral Tablet 2.5MG 18250 PHARMACY 3806786NF-TOPIRAMATE ORAL TABLET 50MG 14.82250 PHARMACY 3806787NF-CELEBREX CAP 100MG 6.56250 PHARMACY 3806788NF-CELEBREX CAP 200MG 24.49250 PHARMACY 3806790NF-Phentermine Hydrochloride Capsule 37. 4250 PHARMACY 3806791NF-Glycopyrrolate Oral Tablet 1MG 3250 PHARMACY 3806792NF-Mucinex DM Tab ER 1250 PHARMACY 3806793Ipratropium 0.02% 5250 PHARMACY 3806794Celecoxib 200mg 5250 PHARMACY 3806796NF-Vyvanse Oral Capsule 30MG 38250 PHARMACY 3806797NF-ZyrTEC Oral Tablet 5MG 8250 PHARMACY 3806798NF-Metoprolol Succinate ER Tab ER 100MG 4250 PHARMACY 3806799NF-Lisinopril Oral Tablet 20MG 3250 PHARMACY 3806800NF-Dicloxacillin Oral Capsule 500MG 5250 PHARMACY 3806803NF-Progesterone Oral Capsule 200MG 12250 PHARMACY 3806804NF-Symbicort Inh Aer Liq 160MCG-4.5MCG 79250 PHARMACY 3806805NF-Fenofibrate Micronized Cap 134MG 5250 PHARMACY 3806807NF-Metoprolol Succinate Oral Tab ER 100M 4250 PHARMACY 3806810NF-Rasagiline Oral Tablet 1MG 74250 PHARMACY 3806815NF-Desipramine HCl Oral Tablet 25MG 3250 PHARMACY 3806816NF-Telmisartan Oral Tablet 20MG 16250 PHARMACY 3806817NF-Potassium Chlor Tab 8MEQ 1250 PHARMACY 3806818NF-Levitra Oral Tablet 20MG 31250 PHARMACY 3806822NF-Carvedilol Oral Tablet 6.25MG 11250 PHARMACY 3806825NF-Lipitor Tablet 80MG 20250 PHARMACY 3806826NF-NovoLIN 70/30 SubQ Susp 70U-30U/1ML 12250 PHARMACY 3806827NF-Allegra-D Oral Tab ER 60MG-120MG 7250 PHARMACY 3806830NF-Cartia XT Oral 24 Hr Cap ER 240MG 6250 PHARMACY 3806831NF-Cetirizine Hydrochloride Chew Tab 10M 7250 PHARMACY 3806833NF-Nabumetone Oral Tablet 500MG 3250 PHARMACY 3806836NF-Culturelle Oral Capsule 10 Billion OR 3250 PHARMACY 3806837NF-Flovent HFA Inh Oral/Neb 0.22MG/1Act 120250 PHARMACY 3806839NF-Terazosin HCl Capsule 1MG 4250 PHARMACY 3806840NF-Cleocin HCl Oral Capsule 300MG 1250 PHARMACY 3806841NF-Doxepin HCl Tablet 6MG 48250 PHARMACY 3806842NF-Fortesta Gel 10MG/0.5GM 24250 PHARMACY 3806843NF-Neupro TD Patch ER 4MG/24HR 84250 PHARMACY 3806844NF-Glucovance Tablet 5250 PHARMACY 3806845NF-Alendronate Sodium Oral Tablet 70MG 61250 PHARMACY 3806846NF-Amitriptyline HCl Tablet 75MG 3250 PHARMACY 3806848NF-Allegra-D 12 Hour Tab ER 60MG-120MG 7250 PHARMACY 3806849NF-Rozerem Oral Tablet 8MG 46250 PHARMACY 3806850NF-Aciphex Enteric Coated Tablet 20MG 62250 PHARMACY 3806851NF-Claritin-D Oral 24 hr Tab ER 10MG 4250 PHARMACY 3806852NF-Topiramate Oral Tablet 100MG 18250 PHARMACY 3806853NF-Isosorbide Dinitrate Oral Tablet 5MG 2250 PHARMACY 3806855NF-Xeljanz Oral Tablet 5MG 282250 PHARMACY 3806859NF-Venlafaxine HCl Oral Tab ER 150MG 12250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806860NF-Propranolol Hydrochloride Tablet 80MG 2250 PHARMACY 3806861NF-Salagen Oral Tablet 5MG 6250 PHARMACY 3806862NF-Topiramate Oral Tablet 200MG 24250 PHARMACY 3806864NF-Glimepiride Oral Tablet 1MG 1250 PHARMACY 3806867NF-Dicloxacillin Oral Capsule 500MG 5250 PHARMACY 3806868NF-Rexulti Oral Tablet 4MG 139250 PHARMACY 3806869NF-Olmesartan Medoxomil Oral Tablet 5MG 16250 PHARMACY 3806875NF-methylPREDNISolone Oral Tablet 8MG 6250 PHARMACY 3806876NF-methylPREDNISolone Oral Tablet 8MG 6250 PHARMACY 3806877NF-Ursodiol Oral Capsule 300MG 22250 PHARMACY 3806878NF-Premarin Oral Tablet 0.45MG 21250 PHARMACY 3806879NF-METOPROLOL ORAL TABLET 25MG 1.57250 PHARMACY 3806880NF-Coreg CR Oral Capsule ER 80MG 33250 PHARMACY 3806882NF-Micardis HCT Tablet 80MG-25MG 25250 PHARMACY 3806883NF-Simvastatin Oral Tablet 80MG 14250 PHARMACY 3806884NF-Pilocarpine HCl Oral Tablet 5MG 9250 PHARMACY 3806885NF-LaMICtal XR Extended Release Tab 300M 142250 PHARMACY 3806886NF-Lithobid Tablet, Extended Release 300 41250 PHARMACY 3806889NF-dilTIAZem CD Capsule ER 300MG 19250 PHARMACY 3806891NF-BRIVIACT TAB 50MG 70.76250 PHARMACY 3806892NF-RAMELTEON ORAL TABLET 8MG 43.77250 PHARMACY 3806893NF-STERILE WATER FOR INJECTION SOLUTION 0.02250 PHARMACY 3806894NF-STERILE WATER FOR INJECTION SOLUTION 0.02250 PHARMACY 3806895Sterile Water for Injection 11.88258 IV SOLUTIONS 3806898NF-Flecainide Acetate Tablet 50MG 6250 PHARMACY 3806899NF-Citalopram Oral Tablet 20MG 6250 PHARMACY 3806900NF-Esomeprazole Magnesium Oral Cap DR 40 49250 PHARMACY 3806901NF-Furosemide Oral Tablet 20MG 1250 PHARMACY 3806902NF-Levothyroxine Oral Tablet 75MCG 1250 PHARMACY 3806903NF-Potassium Chloride Oral Tab ER 20MEQ 2250 PHARMACY 3806905NF-Alendronate Sodium Oral Tablet 70MG 61250 PHARMACY 3806906NF-amLODIPine-Olmesartan Oral Tab 5MG-40 29250 PHARMACY 3806907NF-Estradiol TD Patch ER 0.1MG/24HR 73250 PHARMACY 3806908NF-Liothyronine Sodium Oral Tablet 25MCG 3250 PHARMACY 3806909NF-Colesevelam HCl Oral Tablet 625MG 11250 PHARMACY 3806911NF-Sucralfate Oral Suspension 1GM/10ML 3250 PHARMACY 3806912NF-Infumorph 200 Injection 23250 PHARMACY 3806913NF-lamoTRIgine Oral Tablet 150MG 15250 PHARMACY 3806914NF-QUEtiapine Fumarate Oral Tablet 400MG 59250 PHARMACY 3806915Bactrim 800mg/160mg IVPB 110250 PHARMACY 3806916NF-Entresto Oral Tablet 24MG-26MG 32250 PHARMACY 3806917NF-Indomethacin Oral Capsule 50MG 1250 PHARMACY 3806920NF-Testosterone Topical Cream 20% 22250 PHARMACY 3806922NF-Metoprolol Succinate ER Tab ER 100MG 4250 PHARMACY 3806926NF-Zofran Oral Disintegrating Tablet 4MG 86250 PHARMACY 3806928NF-Triglide Oral Tablet 160MG 34250 PHARMACY 3806929NF-Trihexyphenidyl HCl Tablet 5MG 1250 PHARMACY 3806930NF-DIVALPROEX SODIUM ORAL TAB DR 500MG 2.31250 PHARMACY 3806931NF-Ambien CR Extended-Release Tablet 6.2 66250 PHARMACY 3806934NF-Xanax XR Oral Tablet ER 0.5MG 30250 PHARMACY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

3806935NF-Duexis Oral Tablet 26.6MG-800MG 99250 PHARMACY 3806937NF-Imipramine Oral Tablet 50MG 4250 PHARMACY 3806939NF-Eplerenone Oral Tablet 50MG 13250 PHARMACY 3806940NF-Felodipine Oral Tablet ER 10MG 4250 PHARMACY 3806942NF-Tirosint Liquid Filled Capsule 100MCG 15250 PHARMACY 3806943NF-Diovan HCT Oral Tablet 320MG-25MG 49250 PHARMACY 3806945NF-CREON CAP DR 12.02250 PHARMACY 3806949Metoprolol(ER) Succinate 100mg 25250 PHARMACY 3806950Metoprolol(IR) Tartrate 25mg 20250 PHARMACY 3806956NF-Synthroid Tablet 137MCG 3250 PHARMACY 3806959NF-Xyzal Allergy 24HR Oral Tablet 5MG 1250 PHARMACY 3806961NF-Climara Transderm Patch 0.05MG/24hrs 124250 PHARMACY 3806962NF-Budesonide Delayed Release Capsule 3M 56250 PHARMACY 3806963NF-Rexulti Oral Tablet 1MG 139250 PHARMACY 3806964NF-ZyPREXA Tablet 15MG 117250 PHARMACY 3806965NF-labetalol HCl Oral Tablet 200MG 2250 PHARMACY 3806966NF-fluvoxaMINE Maleate Tablet 50MG 7250 PHARMACY 3806967NF-Trimethoprim Oral Tablet 100MG 2250 PHARMACY 3806968NF-Lisinopril Oral Tablet 20MG 3250 PHARMACY 3806975NF-traMADol HCl Oral Cap ER 150MG 27250 PHARMACY 3806976NF-Loratadine-D 24Hr Tab ER 10MG-240MG 3250 PHARMACY 3806977NF-cevimeline HCl Oral Capsule 30MG 10250 PHARMACY 3806982NF-Fluocinonide Cream 0.05% 9250 PHARMACY 3806984NF-Pregabalin Oral Cap 50MG 23250 PHARMACY 3806985NF-Propranolol Hydrochloride Tablet 10MG 1250 PHARMACY 3806988NF-Tymlos Subcutaneous Solution 2000MCG/ 4537250 PHARMACY 3806989NF-Valsartan and hydroCHLOROthiazide Tab 14250 PHARMACY 3806990NF-glipiZIDE XL Oral Tablet ER 5MG 1250 PHARMACY 3806993NF-guanFACINE HCl Tablet 1MG 2250 PHARMACY 3806999NF-Thyroid Tablet 65MG 1250 PHARMACY 3807001NF-Doxepin HCl Oral Capsule 25MG 2250 PHARMACY 4000001NEBULIZER TREATMENT 100410 RESPIRATORY THER 4000002VENTILATOR MANAGEMENT INITIAL 1075410 RESPIRATORY THER 4000003CPAP 791410 RESPIRATORY THER 4000004EDUCATION/VAPOR INHAL INIT 159410 RESPIRATORY THER 4000005BIPAP 791410 RESPIRATORY THER 4000006EKG 143730 EKG/EEG 4000007IPPB 149410 RESPIRATORY THER 4000008CPT INITIAL 139410 RESPIRATORY THER 4000009CPT SUBSEQUENT 139410 RESPIRATORY THER 4000010PULSE OX, SINGLE 100460 PULMONARY FUNC 4000011PULSE OX, MULTIPLE 150460 PULMONARY FUNC 4000012PULSE OX, CONTINUOUS 808460 PULMONARY FUNC 4000013VENT ASSIT SUBSEQUENT DAY 1075410 RESPIRATORY THER 4000014VENTILATOR MANAGEMENT SUBSEQUENT 1075410 RESPIRATORY THER 4000017OXYGEN PER DAY 287410 RESPIRATORY THER 4000020NIV (NONINVASIVE VENTILATION) 791410 RESPIRATORY THER 4100003PT THERAPEUTIC EXERCISES EACH 15 MIN 155421 PHYS THERP/VISIT 4100004PT NEUROM/PROPRIO BALAN 148421 PHYS THERP/VISIT 4100005PT GAIT TRAINING 126421 PHYS THERP/VISIT

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

4100006PT MANUAL THERAPY 133421 PHYS THERP/VISIT 4100007PT THERAPEUTIC ACTIVITIES EACH 15 MIN 155421 PHYS THERP/VISIT 4100008PT REMOVAL TISS 20 CM< 524420 PHYSICAL THER 4100009PT REMOVE TISS ADD 20CM 524420 PHYSICAL THER 4100010PT DEBRID NON SELECTIVE 307421 PHYS THERP/VISIT 4100011PT WOUND VAC TX >50CM 307420 PHYSICAL THER 4100012PT WOUND VAC TX <50 CM 524420 PHYSICAL THER 4100013PT ADL - TRAINING 154420 PHYSICAL THER 4100014PT MOBILITY CURRENT STATUS 0.01429 OTHER PHYS THERP 4100015PT MOBILITY GOAL STATUS 0.01429 OTHER PHYS THERP 4100016PT MOBILITY D/C STATUS 0.01429 OTHER PHYS THERP 4100017PT EVALUATION LOW COMPLEXITY 327.32424 PHYS THERP/EVAL 4100018PT EVALUATION MODERATE COMPLEXITY 327.32424 PHYS THERP/EVAL 4100019PT EVALUATION HIGH COMPLEXITY 327.32424 PHYS THERP/EVAL 4100020PT RE-EVALUATION 222.52424 PHYS THERP/EVAL 4101003PT BODY POS CURRENT G8981-CH 0.01420 PHYSICAL THER 4101004PT BODY POS CURRENT G8981-CI 0.01420 PHYSICAL THER 4101005PT BODY POS CURRENT G8981-CJ 0.01420 PHYSICAL THER 4101006PT BODY POS CURRENT G8981-CK 0.01420 PHYSICAL THER 4101007PT BODY POS CURRENT G8981-CL 0.01420 PHYSICAL THER 4101008PT BODY POS CURRENT G8981-CM 0.01420 PHYSICAL THER 4101009PT BODY POS CURRENT G8981-CN 0.01420 PHYSICAL THER 4101010PT CARRY DC G8986-CH 0.01420 PHYSICAL THER 4101011PT CARRY DC G8986-CI 0.01420 PHYSICAL THER 4101012PT CARRY DC G8986-CJ 0.01420 PHYSICAL THER 4101013PT CARRY DC G8986-CK 0.01420 PHYSICAL THER 4101014PT CARRY DC G8986-CL 0.01420 PHYSICAL THER 4101015PT CARRY DC G8986-CM 0.01420 PHYSICAL THER 4101016PT CARRY DC G8986-CN 0.01420 PHYSICAL THER 4101017PT CARRY GOAL G8985-CH 0.01420 PHYSICAL THER 4101018PT CARRY GOAL G8985-CI 0.01420 PHYSICAL THER 4101019PT CARRY GOAL G8985-CJ 0.01420 PHYSICAL THER 4101020PT CARRY GOAL G8985-CK 0.01420 PHYSICAL THER 4101021PT CARRY GOAL G8985-CL 0.01420 PHYSICAL THER 4101022PT CARRY GOAL G8985-CM 0.01420 PHYSICAL THER 4101023PT CARRY GOAL G8985-CN 0.01420 PHYSICAL THER 4101024PT SELF-CARE DC G8989-CH 0.01420 PHYSICAL THER 4101025PT SELF-CARE DC G8989-CI 0.01420 PHYSICAL THER 4101026PT SELF-CARE DC G8989-CJ 0.01420 PHYSICAL THER 4101027PT SELF-CARE DC G8989-CK 0.01420 PHYSICAL THER 4101028PT SELF-CARE DC G8989-CL 0.01420 PHYSICAL THER 4101029PT SELF-CARE DC G8989-CM 0.01420 PHYSICAL THER 4101030PT SELF-CARE DC G8989-CN 0.01420 PHYSICAL THER 4101031PT SELF-CARE GOAL G8988-CH 0.01420 PHYSICAL THER 4101032PT SELF-CARE GOAL G8988-CI 0.01420 PHYSICAL THER 4101033PT SELF-CARE GOAL G8988-CJ 0.01420 PHYSICAL THER 4101034PT SELF-CARE GOAL G8988-CK 0.01420 PHYSICAL THER 4101035PT SELF-CARE GOAL G8988-CL 0.01420 PHYSICAL THER 4101036PT SELF-CARE GOAL G8988-CM 0.01420 PHYSICAL THER 4101037PT SELF-CARE GOAL G8988-CN 0.01420 PHYSICAL THER

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

4101038PT SUB PT/OT GOAL G8994-CH 0.01420 PHYSICAL THER 4101039PT SUB PT/OT GOAL G8994-CI 0.01420 PHYSICAL THER 4101040PT SUB PT/OT GOAL G8994-CJ 0.01420 PHYSICAL THER 4101041PT SUB PT/OT GOAL G8994-CK 0.01420 PHYSICAL THER 4101042PT SUB PT/OT GOAL G8994-CL 0.01420 PHYSICAL THER 4101043PT SUB PT/OT GOAL G8994-CM 0.01420 PHYSICAL THER 4101044PT SUB PT/OT GOAL G8994-CN 0.01420 PHYSICAL THER 4101045PT BODY POS DC G8983-CH 0.01420 PHYSICAL THER 4101046PT BODY POS DC G8983-CI 0.01420 PHYSICAL THER 4101047PT BODY POS DC G8983-CJ 0.01420 PHYSICAL THER 4101048PT BODY POS DC G8983-CK 0.01420 PHYSICAL THER 4101049PT BODY POS DC G8983-CL 0.01420 PHYSICAL THER 4101050PT BODY POS DC G8983-CM 0.01420 PHYSICAL THER 4101051PT BODY POS DC G8983-CN 0.01420 PHYSICAL THER 4101052PT BODY POS GOAL G8982-CH 0.01420 PHYSICAL THER 4101053PT BODY POS GOAL G8982-CI 0.01420 PHYSICAL THER 4101054PT BODY POS GOAL G8982-CJ 0.01420 PHYSICAL THER 4101055PT BODY POS GOAL G8982-CK 0.01420 PHYSICAL THER 4101056PT BODY POS GOAL G8982-CL 0.01420 PHYSICAL THER 4101057PT BODY POS GOAL G8982-CM 0.01420 PHYSICAL THER 4101058PT BODY POS GOAL G8982-CN 0.01420 PHYSICAL THER 4101059PT CARRY CURRENT G8984 -CH 0.01420 PHYSICAL THER 4101060PT CARRY CURRENT G8984 -CI 0.01420 PHYSICAL THER 4101061PT CARRY CURRENT G8984 -CJ 0.01420 PHYSICAL THER 4101062PT CARRY CURRENT G8984 -CK 0.01420 PHYSICAL THER 4101063PT CARRY CURRENT G8984 -CL 0.01420 PHYSICAL THER 4101064PT CARRY CURRENT G8984 -CM 0.01420 PHYSICAL THER 4101065PT CARRY CURRENT G8984 -CN 0.01420 PHYSICAL THER 4101066PT MOBILITY CURRENT G8978- CH 0.01420 PHYSICAL THER 4101067PT MOBILITY CURRENT G8978- CI 0.01420 PHYSICAL THER 4101068PT MOBILITY CURRENT G8978- CJ 0.01420 PHYSICAL THER 4101069PT MOBILITY CURRENT G8978- CK 0.01420 PHYSICAL THER 4101070PT MOBILITY CURRENT G8978- CL 0.01420 PHYSICAL THER 4101071PT MOBILITY CURRENT G8978- CM 0.01420 PHYSICAL THER 4101072PT MOBILITY CURRENT G8978- CN 0.01420 PHYSICAL THER 4101073PT MOBILITY DC G8980-CH 0.01420 PHYSICAL THER 4101074PT MOBILITY DC G8980-CI 0.01420 PHYSICAL THER 4101075PT MOBILITY DC G8980-CJ 0.01420 PHYSICAL THER 4101076PT MOBILITY DC G8980-CK 0.01420 PHYSICAL THER 4101077PT MOBILITY DC G8980-CL 0.01420 PHYSICAL THER 4101078PT MOBILITY DC G8980-CM 0.01420 PHYSICAL THER 4101079PT MOBILITY DC G8980-CN 0.01420 PHYSICAL THER 4101080PT MOBILITY GOAL G8979-CH 0.01420 PHYSICAL THER 4101081PT MOBILITY GOAL G8979-CI 0.01420 PHYSICAL THER 4101082PT MOBILITY GOAL G8979-CJ 0.01420 PHYSICAL THER 4101083PT MOBILITY GOAL G8979-CK 0.01420 PHYSICAL THER 4101084PT MOBILITY GOAL G8979-CL 0.01420 PHYSICAL THER 4101085PT MOBILITY GOAL G8979-CM 0.01420 PHYSICAL THER 4101086PT MOBILITY GOAL G8979-CN 0.01420 PHYSICAL THER 4101087PT OTHER PT/OT CURRENT G8990-CH 0.01420 PHYSICAL THER

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

4101088PT OTHER PT/OT CURRENT G8990-CI 0.01420 PHYSICAL THER 4101089PT OTHER PT/OT CURRENT G8990-CJ 0.01420 PHYSICAL THER 4101090PT OTHER PT/OT CURRENT G8990-CK 0.01420 PHYSICAL THER 4101091PT OTHER PT/OT CURRENT G8990-CL 0.01420 PHYSICAL THER 4101092PT OTHER PT/OT CURRENT G8990-CM 0.01420 PHYSICAL THER 4101093PT OTHER PT/OT CURRENT G8990-CN 0.01420 PHYSICAL THER 4101094PT OTHER PT/OT DC G8992-CH 0.01420 PHYSICAL THER 4101095PT OTHER PT/OT DC G8992-CI 0.01420 PHYSICAL THER 4101096PT OTHER PT/OT DC G8992-CJ 0.01420 PHYSICAL THER 4101097PT OTHER PT/OT DC G8992-CK 0.01420 PHYSICAL THER 4101098PT OTHER PT/OT DC G8992-CL 0.01420 PHYSICAL THER 4101099PT OTHER PT/OT DC G8992-CM 0.01420 PHYSICAL THER 4101100PT OTHER PT/OT DC G8992-CN 0.01420 PHYSICAL THER 4101101PT OTHER PT/OT GOAL G8991-CH 0.01420 PHYSICAL THER 4101102PT OTHER PT/OT GOAL G8991-CI 0.01420 PHYSICAL THER 4101103PT OTHER PT/OT GOAL G8991-CJ 0.01420 PHYSICAL THER 4101104PT OTHER PT/OT GOAL G8991-CK 0.01420 PHYSICAL THER 4101105PT OTHER PT/OT GOAL G8991-CL 0.01420 PHYSICAL THER 4101106PT OTHER PT/OT GOAL G8991-CM 0.01420 PHYSICAL THER 4101107PT OTHER PT/OT GOAL G8991-CN 0.01420 PHYSICAL THER 4101108PT SELF-CARE CURRENT G8987-CH 0.01420 PHYSICAL THER 4101109PT SELF-CARE CURRENT G8987-CI 0.01420 PHYSICAL THER 4101110PT SELF-CARE CURRENT G8987-CJ 0.01420 PHYSICAL THER 4101111PT SELF-CARE CURRENT G8987-CK 0.01420 PHYSICAL THER 4101112PT SELF-CARE CURRENT G8987-CL 0.01420 PHYSICAL THER 4101113PT SELF-CARE CURRENT G8987-CM 0.01420 PHYSICAL THER 4101114PT SELF-CARE CURRENT G8987-CN 0.01420 PHYSICAL THER 4101115PT SUB PT/OT CURRENT G8993-CH 0.01420 PHYSICAL THER 4101116PT SUB PT/OT CURRENT G8993-CI 0.01420 PHYSICAL THER 4101117PT SUB PT/OT CURRENT G8993-CJ 0.01420 PHYSICAL THER 4101118PT SUB PT/OT CURRENT G8993-CK 0.01420 PHYSICAL THER 4101119PT SUB PT/OT CURRENT G8993-CL 0.01420 PHYSICAL THER 4101120PT SUB PT/OT CURRENT G8993-CM 0.01420 PHYSICAL THER 4101121PT SUB PT/OT CURRENT G8993-CN 0.01420 PHYSICAL THER 4101122PT SUB PT/OT DC G8995-CH 0.01420 PHYSICAL THER 4101123PT SUB PT/OT DC G8995-CI 0.01420 PHYSICAL THER 4101124PT SUB PT/OT DC G8995-CJ 0.01420 PHYSICAL THER 4101125PT SUB PT/OT DC G8995-CK 0.01420 PHYSICAL THER 4101126PT SUB PT/OT DC G8995-CL 0.01420 PHYSICAL THER 4101127PT SUB PT/OT DC G8995-CM 0.01420 PHYSICAL THER 4101128PT SUB PT/OT DC G8995-CN 0.01420 PHYSICAL THER 500000164626 - DESTRUCTION BY NEUROLYTIC AGENT 2828360 OR SERVICES 500000264627 - DESTRUCTION BY NEUROLYTIC AGENT 2828360 OR SERVICES 500000396365 TX/PROPH/DG UP TO 1 HOUR 731260 IV THERAPY 5000004PUNCTURE, PERIT CAVI 1762360 OR SERVICES 5000005BIOPSY LUNG 3568360 OR SERVICES 5000006INSERT PICC CATH>5 3915360 OR SERVICES 500000738220 BONE MARROW ASPIRATI 5490360 OR SERVICES 5000008PUNCTURE PERITO CAV 1762360 OR SERVICES 500000961070 INJECTION SHUNTOGRAM 2183360 OR SERVICES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

500001064455 N BLOCK INJ PLANTAR 1047360 OR SERVICES 500001164633 DESTROY CERV/THOR FA 4512360 OR SERVICES 500001264634 DESTROY C/TH FACET J 914360 OR SERVICES 5000013DESTROY LUMB/SAC FAC 4512360 OR SERVICES 500001464636 DESTROY L/S FACET JN 2829360 OR SERVICES 500001596366 TX/PROPH/DG EACH ADDL HOUR 135260 IV THERAPY 5000016 62268 PERCUTANEOUS ASP SPINAL CORD CYST 1286.45 360 OR SERVICES 500002162310 EPI STEROID INJ C/T 2829360 OR SERVICES 500002262311 EPI STEROID INJ LUM 2829360 OR SERVICES 500002362362 IMPLANT RES/PRG PUMP 3980360 OR SERVICES 500002463650 PERCUTANEOUS IMP ELE 4460360 OR SERVICES 500002564400 INJ TRIGEMINAL 913.05360 OR SERVICES 500002664405 OCCIPITAL NERVE BLOC 2306360 OR SERVICES 500002764420 INTERCOSTAL NERV BLO 1930360 OR SERVICES 500002864421 INTERCOSTAL NERV MUL 2829360 OR SERVICES 500002964479 INJ FORAMEN EPI C/T 2829360 OR SERVICES 500003064480 INJ FORAMEN EPI C/T 1459360 OR SERVICES 500003164483 TRANFORAMINAL INJ L 2829360 OR SERVICES 500003264484 TRAN.INJ.ADD.LEVEL 2106360 OR SERVICES 500003364490 INJ FACET C/T 1 LEVE 2829360 OR SERVICES 500003464491 INJ FACET C/T 2 LEVE 914360 OR SERVICES 500003564492 INJ FACET C/T 3 LEVE 914360 OR SERVICES 500003664493 INJ FACET L/S 1 LEVE 2829360 OR SERVICES 500003764494 INJ FACET L/S 2 LEVE 914360 OR SERVICES 500003864495 INJ FACET L/S 3 LEVE 914360 OR SERVICES 500003964510 INJ STELLATE 2829360 OR SERVICES 500004064520 INJ SYMPATHETIC 2829360 OR SERVICES 500004164530 INJ CELIAC PLEXUS 2829360 OR SERVICES 500004264600 DEST NURO AG TRIGNER 4238360 OR SERVICES 500004364620 INJ. INTER NERVE 4283360 OR SERVICES 500004464640 NEUROLYSIS OTHER 2829360 OR SERVICES 500004564999 UNLISTD PROC NER SYS 913360 OR SERVICES 500004662273 EPIDURAL BLOOD PATCH 2829360 OR SERVICES 500004727093 INJ HIP ARTHROGRAPHY 806360 OR SERVICES 500004827096 INJ SI ARTHROGRAPHY 2614360 OR SERVICES 500004962290 DISKOGRAPHY LUMBAR 800360 OR SERVICES 500005062291 DISKOGRAPHY CERVICAL 800360 OR SERVICES 500005120550 INJ TNDN SHEATH LIG 2306360 OR SERVICES 500005220551 INJECTION TENDON 2306360 OR SERVICES 500005320552 INJ 1 - 2 MUSCLE GRP 2306360 OR SERVICES 500005420553 INJ 3 PLUS MUSCLE GR 1930360 OR SERVICES 500005520600 ARTHRO ASPIR &/OR IN 1930360 OR SERVICES 500005620605 ARTHRCNTSIS INJ INT 1896360 OR SERVICES 500005720610 ARTHRCNTSIS INJ MAJO 756360 OR SERVICES 500005810009 FNA W/CT 1ST LESION 571.9360 OR SERVICES 500005996372 THER/PROPH/DIAG INJ 196360 OR SERVICES 500006096374 IV PUSH MEDS 196360 OR SERVICES 500006196375 TX/PRO/DX INJ NEW DR 196360 OR SERVICES 500006296376 IV PUSH ADD ON 195360 OR SERVICES 500006310160 PUNCTURE DRAINAGE 627.25360 OR SERVICES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

500006411900 INJ SKIN LESION 536360 OR SERVICES 500006523350 INJ PROC SHOULDER AR 1930360 OR SERVICES 500006627095 INJ FOR ATHRO.W ANES 1520360 OR SERVICES 5000067 G0260 INJECTION PROCEDURE FOR SACROILIAC 2829 360 OR SERVICES 500006899144 CONSCIOUS SEDATION 100370 ANESTHESIA 500006964517 INJECTION ANESTHETIC AGENT; SUPERI 2829360 OR SERVICES 500007064450 INJECTION ANESTHETIC AGENT; OTHER 1459360 OR SERVICES 500007277002 FLUOROSCOPIC GUIDANCE FOR NEEDLE P 426320 RADIOLOGY 500007377002 ADD'L LEVELS FLUOROSCOPIC GUIDANCE 50320 RADIOLOGY 500007477003 FLUOROSCOPIC GUIDANCE AND LOCALIZA 426320 RADIOLOGY 500007577003 ADD'L LEVELS FLUOROSCOPIC GUIDANCE 50320 RADIOLOGY 5000076 72275 EPIDUROGRAPHY RADIOLOGICAL SUPERVI 1078 320 RADIOLOGY 500007772285 DISCOGRAPHY CERVICAL OR THORACIC R 2500320 RADIOLOGY 500007872285 ADD'L LEVELS DISCOGRAPHY CERVICAL 1450320 RADIOLOGY 5000079 72295 DISCOGRAPHY LUMBAR RADIOLOGICAL SU 2500 320 RADIOLOGY 5000080 72295 ADD'L LEVEL DISCOGRAPHY LUMBAR RAD 1450 320 RADIOLOGY 500008162291 ADD'L LEVELS INJECTION PROCEDURE F 650360 OR SERVICES 500008262290 ADD'L LEVEL INJECTION PROCEDURE FO 650360 OR SERVICES 500008376942 ULTRASONIC GUIDANCE FOR NEEDLE PLA 100402 ULTRASOUND 5000084 64635 DESTRUCTION BY NEUROLYTIC AGENT PA 4512 360 OR SERVICES 5000085 64430 INJECTION ANESTHETIC AGENT; PUDEND 2828 360 OR SERVICES 500008662319 INJECTION(S) INCLUDING INDWELLING 4283360 OR SERVICES 500008799145 CONSCIOUS SEDATION EACH 15 MINUTES 100370 ANESTHESIA 500008832405 BIOPSY LUNG 3568360 OR SERVICES 500008938505 BIOPSY LYMPH NODE(S); BY NEEDLE SU 3126360 OR SERVICES 500009050200 RENAL BIOPLSY 3568360 OR SERVICES 500009160100 BIOPSY THYROID 1728360 OR SERVICES 500009275809 SHUNTOGRAM FOR INVESTIGATION OF PR 354320 RADIOLOGY 5000093 62269 BIOPSY OF SPINAL CORD PERCUTANEOUS 3568 360 OR SERVICES 5000094 62264 PERCUTANEOUS LYSIS OF EPIDURAL ADH 4283 360 OR SERVICES 5000095 49083 ABDOMINAL PARACENTESIS (DIAGNOSTIC 2062 360 OR SERVICES 500009662282 TREAT SPINAL CANAL LESION 4283360 OR SERVICES 500009764505 N BLOCK SPENOPALATINE GANGL 1011360 OR SERVICES 500009864425 N BLOCK INJ ILIO-ING/HYPOGI 1770360 OR SERVICES 500009920526 THER INJECTION CARP TUNNEL 1011360 OR SERVICES 500010062318 INJECT SPINE W/CATH CRV/THRC 3500360 OR SERVICES 5000101BONE BIOPSY TROCAR/NEEDLE 5732360 OR SERVICES 5000102N BLOCK INJ FEM SINGLE 1770360 OR SERVICES 5000103N BLOCK INJ SCIATIC SNG 3350360 OR SERVICES 500010464555 IMPLANT NEUROELECTRODES 26453.25360 OR SERVICES 5000105GUIDE CATHET FLUID DRAINAGE 4330360 OR SERVICES 5000106 PERCUTANEOUS ASPIRATION WITHIN THE NUCLE 2437 360 OR SERVICES 5000107BIOPSY MUSCLE PERCUTANEOUS NEEDLE 5264360 OR SERVICES 5000108ARTHROCENTESIS ASPIRATION AND/OR INJECTI 1056360 OR SERVICES 5000109 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY 13011 360 OR SERVICES 5000110 PERCUTANEOUS VERTEBROPLASTY (BONE BIOPSY 6506 360 OR SERVICES 5000111 PERCUTANEOUS VERTEBRAL AUGMENTATION INCL 31779 360 OR SERVICES 5000112 PERCUTANEOUS VERTEBRAL AUGMENTATION INCL 31779 360 OR SERVICES 5000113ASPIRATION AND/OR INJECTION OF GANGLION 1119360 OR SERVICES 5000114 BIOPSY ABDOMINAL OR RETROPERITONEAL MASS 4709.9 360 OR SERVICES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

5000115 62320 EPI STEROID INJ CRV/ THRC WITHOUT 2535.95 360 OR SERVICES 5000116 62321 EPI STEROID INJ CRV/ THRC WITH IMA 2535.95 360 OR SERVICES 5000117 62322 EPI STEROID INJ LUM/SAC WITHOUT IM 2535.95 360 OR SERVICES 5000118 62323 EPI STEROID INJ LUM/SAC WITH IMAGI 2535.95 360 OR SERVICES 5000119 62324 INJECT SPINE W/CATH CRV/THRC WITHO 3194.65 360 OR SERVICES 5000120 62325 INJECT SPINE W/CATH CRV/THRC WITH 3194.65 360 OR SERVICES 5000121 62326 INJECT SPINE W/CATH LUM/SAC WITHOU 3194.65 360 OR SERVICES 5000122 62327 INJECT SPINE W/CATH LUM/SAC WITH I 3194.65 360 OR SERVICES 500012399152 MODERATE SEDATION FIRST 15 MINUTES 100370 ANESTHESIA 500012499153 MODERATE SEDATION EACH ADDITIONAL 100370 ANESTHESIA 5000125BIOPSY OF SALIVARY GLAND; NEEDLE 1617.33360 OR SERVICES 500012662319 INJECT SPINE W/CATH LUMBAR 3288.4360 OR SERVICES 500012764622 - DESTRUCTION BY NEUROLYTIC AGENT 2828360 OR SERVICES 5000128PUMP ROTOR STUDY 757.89360 OR SERVICES 5000129 ROTOR PUMP STUDY WITHOUT PROGRAMMING 757.89 360 OR SERVICES 5000130DRAIN CEREBROSPINAL FLUID 1521.57360 OR SERVICES 500013164418 INJECTION, ANESTH AGENT; SUPRASCAP 1864360 OR SERVICES 5000132 DESTRUCTION OF INTRAOSSEOUS BASIVERTEBRA 32141.64 360 OR SERVICES 5000133 DESTRUCTION OF INTRAOSSEOUS BASIVERTEBRA 100 360 OR SERVICES 500013464623 - DESTRUCTION BY NEUROLYTIC AGENT 2828360 OR SERVICES 500015010010 FNA W/CT EA ADDL LESION 430.67360 OR SERVICES 500019264625 SI JOINT ABLATION 2828360 OR SERVICES 500019464624 NEUROLYSIS GENICULAR NERVE BRANCH 3438360 OR SERVICES 500019664451 INJECTION NERVES INNERV SI JOINT 1875360 OR SERVICES 500019964454 INJECTION NERVES GENICULAR 1875360 OR SERVICES 5000201 20251 BIOPSY VERTEBR BDY OPEN; LUM/CERV 2088.61 360 OR SERVICES 500020295991 REFILL INTRATHECAL PUMP 785940 OTHER RX SVS 5000204 20982 ABLATION BONE TUMOR PERCUTANEOUS 17945.85 360 OR SERVICES 6200001NUTRITION THERAPY INITIAL EACH 15 MIN 137942 EDUC/TRAINING 6200002NUTRITION RE-ASSESSMENT EACH 15 MIN 80942 EDUC/TRAINING 7500001MSLT 2200920 OTHER DX SVS 7500002DIAGNOSTIC STUDY 4200920 OTHER DX SVS 7500003CPAP TITRATION 4500920 OTHER DX SVS 7500004SPLIT NIGHT 4500920 OTHER DX SVS 60454020IM ULRICH OBELISC END PIECE 11000278 OTHER IMPLANTS 70000001SU VIC 0 CT CR J752D 36270 MED-SUR SUPPLIES 70000002SU VIC 0 CT-1 CR J740D 36272 STERILE SUPPLY 70000003SU VIC 0 CT-1 J946H 6272 STERILE SUPPLY 70000004SU VIC 0 CT2 CR J727D 36272 STERILE SUPPLY 70000005SU VIC 0 CTX CR J764D 36272 STERILE SUPPLY 70000006SU VIC 1 CT CR J753D 36272 STERILE SUPPLY 70000007SU VIC 1 CT1 CR J741D 38272 STERILE SUPPLY 70000008SU VIC 1 CTX CR J765D 36272 STERILE SUPPLY 70000009SU VIC 1 CT 36 J959H 6272 STERILE SUPPLY 70000010SU VIC 2-0 CT1 J945H 6272 STERILE SUPPLY 70000011SU VIC 2-0 CT1 CR J739D 36272 STERILE SUPPLY 70000012SU VIC 2-0 CT2 CR J726D 35272 STERILE SUPPLY 70000013SPONGE COTTON 1/2 X 6 6 30272 STERILE SUPPLY 70000014SPONGE COTTON 1/2 X1/2 6 24272 STERILE SUPPLY 70000015SU VIC 3-0 SH J416H 5272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000016SU VIC 3-0 SH CR J774D 36272 STERILE SUPPLY 70000017SU PDS 3-0 PS-2 Z497G 15272 STERILE SUPPLY 70000018SU ETHIL 3-0 PS-2 1669H 12272 STERILE SUPPLY 70000019SU SILK 3-0 TIES 30 A304 9272 STERILE SUPPLY 70000020SU PROLENE 4-0 PS-2 8682 14272 STERILE SUPPLY 70000021SU VIC 4-0 PS-2 J496H 12272 STERILE SUPPLY 70000022SU VIC 4-0 P-3 J494H 12272 STERILE SUPPLY 70000023SU MONO 4-0 P-3 Y494G 14272 STERILE SUPPLY 70000024SU PDS 4-0 PS-2 Z496G 14272 STERILE SUPPLY 70000025SU NURO 4-0 TF CR C584D 54272 STERILE SUPPLY 70000026SU ETHIL 4-0 PS-2 1667H 12272 STERILE SUPPLY 70000027SU SILK TIES 2-0 18 A185 5272 STERILE SUPPLY 70000028DRAPE IOBAN 35X17 M6650E 20272 STERILE SUPPLY 70000029SLEEVE STERILE 89791 / 5 4272 STERILE SUPPLY 70000031BONE WAX 2.5 GRAM 901 16272 STERILE SUPPLY 70000039GLOVE BIOGEL 6 30560 4272 STERILE SUPPLY 70000040GLOVE BIOGEL 7.5 30575 6272 STERILE SUPPLY 70000041GLOVE BIOGEL 8 30580 4272 STERILE SUPPLY 70000042SU PROLENE 2-0 FS 8685H 9272 STERILE SUPPLY 70000045SYR 20ML LL B-D 302830 4270 MED-SUR SUPPLIES 70000046SYR 30ML LL B-D BF302832 0.84270 MED-SUR SUPPLIES 70000047SYR 60ML LL B-D 309653 4272 STERILE SUPPLY 70000048SYR 10ML CONTROL LL 3096 4272 STERILE SUPPLY 70000054NE 25G 3.5 SPINAL 40518 5272 STERILE SUPPLY 70000055NE 22G 3.5 BD/SPIN 40518 6272 STERILE SUPPLY 70000056NE 22G 5 SPINAL B-D 4051 14272 STERILE SUPPLY 70000057NE 18G 6 SPINAL B-D 4083 15272 STERILE SUPPLY 70000058NE 22G 6 CHIBA B-D 40826 21272 STERILE SUPPLY 70000059NE 20G 3.5 SPINAL B-D 40 5272 STERILE SUPPLY 70000061DRAPE EXTREMITY SHEET 29 27272 STERILE SUPPLY 70000063VOL EXERCISER 5M 001901A 10272 STERILE SUPPLY 70000064AIRWAY NASAL 32FR 247056 7272 STERILE SUPPLY 70000065AIRWAY NASAL 34FR 247064 7272 STERILE SUPPLY 70000066AIRWAY NASAL 28FR 247031 8272 STERILE SUPPLY 70000067PEN SKIN MARKER REG 212M 6272 STERILE SUPPLY 70000068SPONGE RAYTEC XRAY 4X4 7 4272 STERILE SUPPLY 70000070URINAL MALE 4472H14001 4272 STERILE SUPPLY 70000073TAPE TRANSPORE 1CLEAR 15 4270 MED-SUR SUPPLIES 70000074COLLAR SOFT 79-83500 18274 PROSTHETIC DEVICES 70000075DRAPE PEDIATRIC 29492 19272 STERILE SUPPLY 70000076DRAPE U 8474 8272 STERILE SUPPLY 70000077BEDPAN REG CONVENTIONAL 4270 MED-SUR SUPPLIES 70000083TUBE SALEM SUMP 18FR 264 5272 STERILE SUPPLY 70000084TUBE SALEM SUMP 16FR 264 5272 STERILE SUPPLY 70000085BEDPAN/FRACTURE H100-10 4270 MED-SUR SUPPLIES 70000086DRAPE TABLE COVER 8377 5272 STERILE SUPPLY 70000087DRAPE 3/4 SHEET 29350 10272 STERILE SUPPLY 70000088GOWN X-LG 9272 STERILE SUPPLY 70000089DRAPE MAYO STAND COVER 8 4272 STERILE SUPPLY 70000090DRAPE OVERHEAD TABLE 93 20272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000093STERI-STRIP 1/2 R1547 3M 4272 STERILE SUPPLY 70000098COLD PACK INSTANT 6X9 4272 STERILE SUPPLY 70000100SWAB BETADINE 3/PK 4272 STERILE SUPPLY 70000102PADS BLUE 30X30 H30305 4270 MED-SUR SUPPLIES 70000103NEBULIZER MICRO MIST W/T 4272 STERILE SUPPLY 70000104TAPE DURAPORE SILK 1 M15 4270 MED-SUR SUPPLIES 70000105TAPE DURAPORE SILK 2 M15 4270 MED-SUR SUPPLIES 70000106TAPE MICROPORE 1PAPER 15 4270 MED-SUR SUPPLIES 70000107DRESSING TEGADERM 2X2 16 4272 STERILE SUPPLY 70000108DRESSING TEGADERM 6X8 16 5272 STERILE SUPPLY 70000109BANDAGE 6"X5 ECON LF TAN 4270 MED-SUR SUPPLIES 70000110BANDAGE ACE 3 2370003L 26270 MED-SUR SUPPLIES 70000111BANDAGE ACE 4 ELAST W/CL 4270 MED-SUR SUPPLIES 70000112DRESSING KLING 3 2232 4272 STERILE SUPPLY 70000113DRESSING KLING 4 2236 4272 STERILE SUPPLY 70000115DRAIN RESERVOIR JP 00707 18272 STERILE SUPPLY 70000116SUCTION LIN 1000CC 65651 4270 MED-SUR SUPPLIES 70000120TUBE ET 6.5 5-10313 7272 STERILE SUPPLY 70000121TUBE ET 6.0 5-10312 7272 STERILE SUPPLY 70000122TUBE ET 8.0 5-10316 7272 STERILE SUPPLY 70000123TUBE ET 8.5 5-10317 7272 STERILE SUPPLY 70000124TUBE ET 7.5 5-10315 7272 STERILE SUPPLY 70000126DURAPREP 3M 26ML 8630 15270 MED-SUR SUPPLIES 70000130IV SET PCA SET 14277-28 19272 STERILE SUPPLY 70000132TAPE MICROFOAM 4 1528-4 17270 MED-SUR SUPPLIES 70000133BAG PERSONAL BELONG PC72 4270 MED-SUR SUPPLIES 70000134DRAIN JP FLAT 7MM SU13 19272 STERILE SUPPLY 70000135DRAIN HEMOVAC MED SUCTION 4361 32272 STERILE SUPPLY 70000136STOCKING TED SML REG THI 19270 MED-SUR SUPPLIES 70000137STOCKING TED MED REG THI 16270 MED-SUR SUPPLIES 70000138STOCKING TED MED LNG THI 19270 MED-SUR SUPPLIES 70000140STERI-STRIP 1/4 MR1546 3 4272 STERILE SUPPLY 70000141STOCKING TED LG REG THI 18270 MED-SUR SUPPLIES 70000142TRAY SKIN PREP 4468 13272 STERILE SUPPLY 70000143DRAPE STERI 1020 3M 5272 STERILE SUPPLY 70000144DRAPE STERI BUTT 1000 4272 STERILE SUPPLY 70000145IV JELCO 14GA ANES 4418 4272 STERILE SUPPLY 70000149DRAPE STERI 1040 3M 7272 STERILE SUPPLY 70000153CAUTERY TIP CLEANER 31 4272 STERILE SUPPLY 70000154IV SET PUMP CLAVE 14687- 19272 STERILE SUPPLY 70000155DRESSING BIOCLUSIVE BIP0 4272 STERILE SUPPLY 70000157PACK NEURO SNE47BSPML 276272 STERILE SUPPLY 70000159RESP MASK AEROSOL 001206 4270 MED-SUR SUPPLIES 70000160RESP AQUA PAK STERIL 340 4270 MED-SUR SUPPLIES 70000161RESP TUBING VENT 6' 1613 10270 MED-SUR SUPPLIES 70000166SLIPPERS TERRY TREADS LG 4270 MED-SUR SUPPLIES 70000168KIT NRV RT BLK 183A65 32272 STERILE SUPPLY 70000169KIT NRV RT BLK 18364 33272 STERILE SUPPLY 70000170KIT SUTURE REMOVAL 4272 STERILE SUPPLY 70000174IV START KIT IV4740 LATE 6272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000175GRADUATE PITCHER H972-01 4270 MED-SUR SUPPLIES 70000176DRESSING KERLIX 6730 CAS 4272 STERILE SUPPLY 70000177SYR ASEPTO PP4090 4272 STERILE SUPPLY 70000178IV CATH 18X1.25 RADPQ 38 7272 STERILE SUPPLY 70000179IV CATH 20X1.25 RADPQ 38 7272 STERILE SUPPLY 70000180IV CATH 22X1 RADPQ 38 7272 STERILE SUPPLY 70000181MASTISOL 2CC 0496-0523-4 6272 STERILE SUPPLY 70000183BLANKET BAIR HUG LO.BODY 22270 MED-SUR SUPPLIES 70000187DRAPE MED 9355 4272 STERILE SUPPLY 70000189DRESSING ABD COMBI 8X8 K 4272 STERILE SUPPLY 70000190NE 18X6 TUOHY E1860 3321 38272 STERILE SUPPLY 70000191BAG AMBU HUDSON 5372 CS/ 75270 MED-SUR SUPPLIES 70000194MASK 02 W TUBING ADULT 4272 STERILE SUPPLY 70000195CUFF WHITE THIGH ADULT DISP 15270 MED-SUR SUPPLIES 70000196CUFF WHITE LG ADULT DISP 25 12270 MED-SUR SUPPLIES 70000197CUFF WHITE MED ADULT DISP 2 10270 MED-SUR SUPPLIES 70000198CUFF WHITE SM ADULT DISP 25 10270 MED-SUR SUPPLIES 70000199SYR CATH TIP 50CC 30962 4272 STERILE SUPPLY 70000200SPECIMEN COL(NUNS CAP)02 4270 MED-SUR SUPPLIES 70000201TRAY CATH STRAIGHT 16FR 8272 STERILE SUPPLY 70000202GOWN XX-LG KIM-CLARK 951 17272 STERILE SUPPLY 70000203STOCKINETTE 4X36 STERILE 24270 MED-SUR SUPPLIES 70000205CATHETER SUCTION 18FR KT 4272 STERILE SUPPLY 70000208DRESSING TELFA 3X8 KC123 4272 STERILE SUPPLY 70000209DRESSING TELFA 3X4 KC105 4272 STERILE SUPPLY 70000211LOTION REMOVER .5 OZ PKT 4270 MED-SUR SUPPLIES 70000212SPONGE 4X4 2/PK STERILE 4272 STERILE SUPPLY 70000213HYDROGEN PEROXIDE 4 OZ 4270 MED-SUR SUPPLIES 70000214TAPE MICROFOAM 2 1528-2 9270 MED-SUR SUPPLIES 70000215TAPE MICROFOAM 3 1528-3 14270 MED-SUR SUPPLIES 70000218ELECTRODE PK/5 BX/1000 5 4270 MED-SUR SUPPLIES 70000219STAPLER REMOVER SKIN 5272 STERILE SUPPLY 70000221CUP TUMBLER CS/500 2069 5272 STERILE SUPPLY 70000222ENEMA KIT W/SOAP ENBG150 7.28270 MED-SUR SUPPLIES 70000226DRESSING TEGADERM 4X10 1 5272 STERILE SUPPLY 70000228HEADREST SLOTTED PURPLE 15270 MED-SUR SUPPLIES 70000231SPONGE 2X2 2/PK STERILE 4272 STERILE SUPPLY 70000232CATHETER INTRADISCAL 721 4600272 STERILE SUPPLY 70000233NE INTRODUCER 17G 72096 218272 STERILE SUPPLY 70000234CATH TRIPLE LUMEN 7F. AK 355.4272 STERILE SUPPLY 70000235CATH RADIAL ARTERY RA040 44272 STERILE SUPPLY 70000239TAPE MICROPORE 2PAPER 15 4270 MED-SUR SUPPLIES 70000240DRESSING XEROFORM 2X2 BX 4272 STERILE SUPPLY 70000241KIT ART LINE MX9505T 36272 STERILE SUPPLY 70000242DRAPE LAPAROTOMY TIBURO 21272 STERILE SUPPLY 70000243DRAPE UTILITY 26X15 4272 STERILE SUPPLY 70000244BAG PRESSURE INFUSER 40 29270 MED-SUR SUPPLIES 70000245BAND ESMARK 4 LF 836-341 5270 MED-SUR SUPPLIES 70000246STOCKING TED LG LONG THI 19270 MED-SUR SUPPLIES 70000247SPONGE LAP 8X36 419 7272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000251BENZOIN COMPOUND C1544 4272 STERILE SUPPLY 70000254IRRIG NS 3000ML 797208 17272 STERILE SUPPLY 70000255SOL BETADINE 4OZ 29906-0 4270 MED-SUR SUPPLIES 70000256CUP SPECIMEN STERILE 4 O 4272 STERILE SUPPLY 70000258STOCKING TED XL REG THI 19270 MED-SUR SUPPLIES 70000259DRESSING COBAN 3" CAH35L 4272 STERILE SUPPLY 70000260DRESSING COBAN 4 1584 3M 5272 STERILE SUPPLY 70000262ROD TSRH TI 5.5 855011 1255278 OTHER IMPLANTS 70000263IRRIG .9% NACL 1000 L071 7272 STERILE SUPPLY 70000264IV SET PRIM GRAVITY 126 15272 STERILE SUPPLY 70000265IV BLOOD PLUMSET 14212-2 73272 STERILE SUPPLY 70000266IV SET EXT TWIN 12678-2 9272 STERILE SUPPLY 70000267IV SET SECONDARY 14230-2 4272 STERILE SUPPLY 70000268IV MICROCLAVE HEP LOCK C 4272 STERILE SUPPLY 70000269IV BLOOD SET Y-TYPE 1243 12272 STERILE SUPPLY 70000270STOPCOCK 3-WAY MEDX MX43 4272 STERILE SUPPLY 70000271IV EXT LARGE BORE 12660- 8272 STERILE SUPPLY 70000272GLOVE BIOGEL 6.5 30565 4272 STERILE SUPPLY 70000273DRAPE MICROSCOPE 5950-12 118272 STERILE SUPPLY 70000274DRAPE BAND BG FLORO/BB36 9272 STERILE SUPPLY 70000275DRAPE X-RAY CASSETTE 995 8272 STERILE SUPPLY 70000276CORD BIPOLAR 10-4000 14272 STERILE SUPPLY 70000283SEAT TOILET RAISED G3025 51270 MED-SUR SUPPLIES 70000284SU PDS # 1 XLH Z881G 19272 STERILE SUPPLY 70000286SYR LOR 10CC BBRAUN 332 9272 STERILE SUPPLY 70000287DRAIN SNYDER 1/8 0073310 106272 STERILE SUPPLY 70000288COLLAR ASPEN ADU/SHORT 9 160274 PROSTHETIC DEVICES 70000289GLOVE BIOGEL 7 30570 4272 STERILE SUPPLY 70000290PINS SKULL MAYFIELD 3006 101270 MED-SUR SUPPLIES 70000291IRRIGATOR SIMPULSE 00677 170272 STERILE SUPPLY 70000292HEADREST 7COM/FOAM CF100 28270 MED-SUR SUPPLIES 70000293SU PROLENE 3-0 PS-2 8687 14272 STERILE SUPPLY 70000294SU SILK 2-0 PS 1588H 12272 STERILE SUPPLY 70000295SU VIC 3-0 PS-1 J683H 14272 STERILE SUPPLY 70000296SU VIC 4-0 SH CR J773D 36272 STERILE SUPPLY 70000297DRESSING COBAN 2 LF TAN 4272 STERILE SUPPLY 70000298CAUTERY TIP 2.5 EZ CLEA 17272 STERILE SUPPLY 70000299CAUTERY TIP 4M EZ CLEA 0 16272 STERILE SUPPLY 70000300CAUTERY PAD VALLEYLAB 7 12272 STERILE SUPPLY 70000301SOFT ROLL 3 SYNTH MCMW0 4272 STERILE SUPPLY 70000302DIAPERS ADULT XL PULL UP 27270 MED-SUR SUPPLIES 70000303SU SILK 0 TIES A306H 5272 STERILE SUPPLY 70000304SU SILK 0 SH K834H 4272 STERILE SUPPLY 70000305NE # 5 TROCAR/MAYO 1826 15272 STERILE SUPPLY 70000306NE # 14 FERGUSON 1842- 6272 STERILE SUPPLY 70000307NE 23G 3.5 REGANES RMPS2 16272 STERILE SUPPLY 70000311CATHETER RR 10FR 0094100 4272 STERILE SUPPLY 70000312TAPE UMBILICAL 30 U11T 5270 MED-SUR SUPPLIES 70000313DRESSING TEGADERM 4X4 16 4272 STERILE SUPPLY 70000314CAUTERY TIP 6.5 BLUE 20272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000315COLLAR ASPEN CHILD REG 9 160274 PROSTHETIC DEVICES 70000316SUPPORT LUMBAR 3XLG OC25 94270 MED-SUR SUPPLIES 70000317SUPPORT LUMBAR MED OC25 91270 MED-SUR SUPPLIES 70000318SUPPORT LUMBAR LG OC25 91270 MED-SUR SUPPLIES 70000319SUPPORT LUMBAR XLG OC25 91270 MED-SUR SUPPLIES 70000320SUPPORT LUMBAR 2XL OC25- 91270 MED-SUR SUPPLIES 70000324TRAY PHYS/IND SI/SHT 138 44272 STERILE SUPPLY 70000325TRAY PHYS/IND MARS.345125A 54272 STERILE SUPPLY 70000326ADAPTER M/LL DBL MX493 M 4270 MED-SUR SUPPLIES 70000327EMESIS EME-BAG 40OZ 24/S 4270 MED-SUR SUPPLIES 70000328CAUT COATED E1455 BL/INSUL. E1 24272 STERILE SUPPLY 70000329DRESSING COBAN 4 L/F 208 9272 STERILE SUPPLY 70000330DRESSING COBAN 6 L/F 208 14272 STERILE SUPPLY 70000331STOCKNETTE IMPERVIOUS 1 15270 MED-SUR SUPPLIES 70000332STAR SLEEVE REG AR-1606 280272 STERILE SUPPLY 70000333SU ETHILON 3-0 PSL 30169 13272 STERILE SUPPLY 70000334SU SILK 3-0 SH 30 K832H 5272 STERILE SUPPLY 70000336SU MONO 4-0 PS-1 Y935H 20272 STERILE SUPPLY 70000337BAND ESMARK 6 LF 1314055 27270 MED-SUR SUPPLIES 70000339KIT RAPID RESPONSE K05L3 383272 STERILE SUPPLY 70000341SUCTION 8FR FRAZIER 0033 10270 MED-SUR SUPPLIES 70000342DRESSING ADAPTIC 3X3 201 4272 STERILE SUPPLY 70000343DRESSING ADAPTIC 3X16 20 4272 STERILE SUPPLY 70000344SU VIC 2-0 CT J351H 6272 STERILE SUPPLY 70000345BOWL UTILITY 01232 4270 MED-SUR SUPPLIES 70000346SPONGE LAP 4X18 X-RAY D 4272 STERILE SUPPLY 70000347NE 20G 3.5 TUOHY 332168 33272 STERILE SUPPLY 70000350DRAIN BLAKE 10FR 1/8 TRO 165272 STERILE SUPPLY 70000351DRAIN CHEST DRY SUCTION 120272 STERILE SUPPLY 70000352BRIEFS DISPOSABLE XL DB2 4270 MED-SUR SUPPLIES 70000353PAD BLADDER CONTROL (SAM 4270 MED-SUR SUPPLIES 70000359PACK 360 SUPP/ANT SNE47S 333272 STERILE SUPPLY 70000360PACK MIN EXTREMITY SOP47 222272 STERILE SUPPLY 70000362DRESSING TAPE MEDI 6X2 2 11272 STERILE SUPPLY 70000363SU SILK 2-0 TIES 30 SA85 7272 STERILE SUPPLY 70000364GOWN KIT BAIR PAWS XLG 8 71272 STERILE SUPPLY 70000369BL STRYKER SAW 2296-3- 149272 STERILE SUPPLY 70000370DRESSING BIOPATCH BLUE 4150 29272 STERILE SUPPLY 70000371PNEUMOTHORAX SET C-TPT-1 732272 STERILE SUPPLY 70000373SU PDS #1 CT1 Z347H 9272 STERILE SUPPLY 70000374BL STRYKER SAG SAW 22963 118272 STERILE SUPPLY 70000375BL STRYKER SAW 2296-3-5 148272 STERILE SUPPLY 70000376BL STRYKER SAW 2296-3-5 148272 STERILE SUPPLY 70000377SU SURGISEAL SKIN ADH ST 38272 STERILE SUPPLY 70000378SU PDS 0 36 Z358T 9272 STERILE SUPPLY 70000379DRESSING MEDIPORE 2X4 35 4272 STERILE SUPPLY 70000380DRESSING MEDIPORE 3X6 35 4272 STERILE SUPPLY 70000381DRESSING MEDIPORE 3X8 35 4272 STERILE SUPPLY 70000382DRESSING MEDIPORE 3X10 3 4272 STERILE SUPPLY 70000383DRESSING TEGA+ 3586 BX/2 4272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000384DRESSING TEGA+ 3589 5272 STERILE SUPPLY 70000385DRESSING TEGA+ 3590 BX25 6272 STERILE SUPPLY 70000386DRESSING TEGA+ M3591A BX 8272 STERILE SUPPLY 70000387SU VIC 2-0 CTX J369H 5272 STERILE SUPPLY 70000388SU VIC 1 CTX J371H 5272 STERILE SUPPLY 70000392WASHCLOTH CONFORT BATH 7 6272 STERILE SUPPLY 70000394IV JELCO 20GA X 1 ANES 4 4272 STERILE SUPPLY 70000395CATH RADI/ART(SHORT) RA0 38272 STERILE SUPPLY 70000396SU MONO 3-0 PS-2 27 Y427 16272 STERILE SUPPLY 70000399KIT ABG 3CC 4660P-1 4272 STERILE SUPPLY 70000400SU MONO 4-0 PS2 18'UND Y 15272 STERILE SUPPLY 70000401SU ETHIBOND # 1 CX30 36272 STERILE SUPPLY 70000404SCD ELITE THIGH CUFF 304 108270 MED-SUR SUPPLIES 70000405KIT WILSON F W/O HEAD W 59272 STERILE SUPPLY 70000408TRAY EPI/CATH ARROW MS05 164272 STERILE SUPPLY 70000410KIT DRESS/CHANGE CVC DT1 18272 STERILE SUPPLY 70000413KIT JACKSON SPINE TABLE 74272 STERILE SUPPLY 70000414TRAY CAT FOLEY 16F LF 90 44272 STERILE SUPPLY 70000415TUBING ARTHREX PUMP AR-6 200272 STERILE SUPPLY 70000417CANN ARTHREX 8.25 X 9 AR 100272 STERILE SUPPLY 70000418TAPE CLOTH 2 6613 6270 MED-SUR SUPPLIES 70000419TAPE CLOTH 3 7046 10270 MED-SUR SUPPLIES 70000420DRAIN TLS 6640 DRAINAGE 181272 STERILE SUPPLY 70000421SPONGE COTTON 1/2 X 1 67 23272 STERILE SUPPLY 70000422SPONGE COTTON 1 X 1 67- 23272 STERILE SUPPLY 70000423MASK 02 NON-REBREATH 001 4272 STERILE SUPPLY 70000424IRRIG STR WATER 1500 713 12272 STERILE SUPPLY 70000426SU FIBER WIRE 2/5 W/NE A 88272 STERILE SUPPLY 70000427SU ARTHX FIB/WIRE #2 AR- 140272 STERILE SUPPLY 70000428CATH COOK MULTIPURP. G07 560272 STERILE SUPPLY 70000429GL PROTEXIS CLASSIC 6 4272 STERILE SUPPLY 70000431STOCKNETTE 6 X 48 23657 25270 MED-SUR SUPPLIES 70000433SHAMPOO HAIR CAP 7909 8270 MED-SUR SUPPLIES 70000434GRAFT/ BARD FELT PLEDGET 55278 OTHER IMPLANTS 70000435SU ETHIL # 1 CTX 830H 6272 STERILE SUPPLY 70000437SU PROLENE 3-0 SH 8522 20272 STERILE SUPPLY 70000438SU PROLENE 4-0 SH1 30 85 20272 STERILE SUPPLY 70000439SU PROLENE 5-0 RB1 36 8 19272 STERILE SUPPLY 70000440SU PROLENE 4-0 RB1 36 85 19272 STERILE SUPPLY 70000441SU VIC 3-0 SH UND 18 J86 37272 STERILE SUPPLY 70000442SU PROLENE 5-0 RB2 30 87 14272 STERILE SUPPLY 70000443DRESSING IODOFORM 7831 7272 STERILE SUPPLY 70000445SU PROLENE # 2 TP-1 8825 15272 STERILE SUPPLY 70000449SU MONO 3-0 PS1 Y936H 20272 STERILE SUPPLY 70000450SU VIC 3-0 PS1 27 J936H 13272 STERILE SUPPLY 70000452SU MONO 3-0 CT-1 36 Y944 7272 STERILE SUPPLY 70000454BL CLIPPER GEN PURPOSE C 8272 STERILE SUPPLY 70000455NG TUBE ATTACHMENT 9785 9270 MED-SUR SUPPLIES 70000456SU DIS SU/RETRIVER SM 98 236272 STERILE SUPPLY 70000457SU DIS SU/RETRIEVER MED 212272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000458SU DIS SU/RETRIEVER LG 9 212272 STERILE SUPPLY 70000462CAUT TIP 5.7 BAYONET 002 108272 STERILE SUPPLY 70000463DRAPE INST POUCH 3M 1018 5272 STERILE SUPPLY 70000464CATH COUDE 12F 5CC 0102 42272 STERILE SUPPLY 70000465CATH COUDE 14F 5CC 0102 46272 STERILE SUPPLY 70000466CATH COUDE 16F 5CC 0102 42272 STERILE SUPPLY 70000468LOOPS VESSEL RADPQ BLUE 9270 MED-SUR SUPPLIES 70000470NE BO/MARROW 11GX 6 BMNJ 84272 STERILE SUPPLY 70000471IV PUMP CV MICRODRIP 126 15272 STERILE SUPPLY 70000472ELECT QUICK COMBO PHYSIO 100270 MED-SUR SUPPLIES 70000475LIMB HOLDER (RESTRAINT) 17270 MED-SUR SUPPLIES 70000487TAPE DURAPORE SILK 3 M15 7270 MED-SUR SUPPLIES 70000491NE MAYO # 6 1826-6DC 6272 STERILE SUPPLY 70000492NE 22 X 3.5 CHIBA 18369 22272 STERILE SUPPLY 70000493NE 22X8 CHI/BAL DRMARS.1 24272 STERILE SUPPLY 70000496GLOVE RADI RES 9.0 XR499 128272 STERILE SUPPLY 70000497NE HUBER 20 X 3/4012034 31272 STERILE SUPPLY 70000498OXISENSOR OXIMAX MAX-A 43270 MED-SUR SUPPLIES 70000500DRAIN EX/LUM BAG INS-210 173.68272 STERILE SUPPLY 70000501SU ETHIBOND 0 CT1 C/R CX 36272 STERILE SUPPLY 70000502WASHER SYN 4.0 CANU 219 230278 OTHER IMPLANTS 70000503KIT STATLOCK CV0220 26272 STERILE SUPPLY 70000508TUBING TUR/IRG 4/LEAD 15 42272 STERILE SUPPLY 70000509PL SYN 7 HOL TUBULAR 24 373278 OTHER IMPLANTS 70000510CAUTERY ENT VALLEYLAB E2 870272 STERILE SUPPLY 70000511GL PROTEXIS 6.0 LATEX FREE 8272 STERILE SUPPLY 70000512GL PROTEXIS 6.5 LATEX FREE 6272 STERILE SUPPLY 70000513GL PROTEXIS 7.0 LATEX FREE 6272 STERILE SUPPLY 70000514GLOVE PROTG/8 DR ANDR.2D 4272 STERILE SUPPLY 70000515GL PROTEXIS 8.5 LATEX FREE 6272 STERILE SUPPLY 70000516GL PROTEXIS 9.0 LATEX FREE 6272 STERILE SUPPLY 70000517ANES CUSHION INSRT.LG D2 96270 MED-SUR SUPPLIES 70000518K-WIRE SYN 1.6 X 150 29 22278 OTHER IMPLANTS 70000519DRAPE SHOULDER 29367 CA 100272 STERILE SUPPLY 70000520STAPLER PROXIMATE PXW35 24272 STERILE SUPPLY 70000522GLOVE BIOGEL 8.5 30585 4272 STERILE SUPPLY 70000523DRAIN EX/LUM KIT 31192 2360272 STERILE SUPPLY 70000529GLOVE BIOGEL 8.5 LF SKIN 6272 STERILE SUPPLY 70000532NEEDLE COUNTER 3114233 17272 STERILE SUPPLY 70000533CATH FEMALE KIT 8FR 0035 6272 STERILE SUPPLY 70000535IM DURA GUARD PATCH 4X4 1735278 OTHER IMPLANTS 70000536LIGACLIP MUL/CL MED AP M 173272 STERILE SUPPLY 70000537LIGACLIP MUL/CL LG APP.M 175272 STERILE SUPPLY 70000544SUTURE AID BOOTIES 05-2- 10270 MED-SUR SUPPLIES 70000545BLANKET MULTI POSITION U 26270 MED-SUR SUPPLIES 70000546PACK ARTHROSCOPY SOP47AR 280272 STERILE SUPPLY 70000549SU GOR CV-6 TTC-9 6M02 112272 STERILE SUPPLY 70000550MASK CPAP NASAL SWIFT HI 400272 STERILE SUPPLY 70000551MASK CPAP MED FULL FACE 111272 STERILE SUPPLY 70000554CANN ARTHREX 8.25X7 AR-6 100272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000555GUIDE WIRE BENSON CER/G0 148272 STERILE SUPPLY 70000556SU GOR CV-7 TTC-9 7M02A 113272 STERILE SUPPLY 70000557GLOVE BIOGEL 8 ECLIPSE M 6272 STERILE SUPPLY 70000558RESP OPTICHAMBER 27270 MED-SUR SUPPLIES 70000559DRAPE U ORTHO LARGE 8931 33272 STERILE SUPPLY 70000567GOWN SURG LARGE 95111 11272 STERILE SUPPLY 70000569FOOT GARMENT VENAFLOW EL 71270 MED-SUR SUPPLIES 70000570ANES INTUB/ STYLET IS14L 7272 STERILE SUPPLY 70000573HEWSON SU/RETRIEVER 711 658270 MED-SUR SUPPLIES 70000574ANES BITE GARD BLOCK 114 4272 STERILE SUPPLY 70000575CATH FOLEY 12FR 5CC 2WAY 15272 STERILE SUPPLY 70000577CATH EMBOLECTOMY 4F 1208 266272 STERILE SUPPLY 70000578TRAY UROLOGIST DIFFICULT 996272 STERILE SUPPLY 70000579TOURQ/CUFF 24'STE 592102 80272 STERILE SUPPLY 70000580ANES CIRCUIT L/F WMI6723 28270 MED-SUR SUPPLIES 70000581FOLEY DRAIN BAG LEG DISP 7272 STERILE SUPPLY 70000582CATH FOLEY 14FR 5CC 1758 29272 STERILE SUPPLY 70000588SCR SYN 3.0 12M 2048 210278 OTHER IMPLANTS 70000589SCR SYN 3.5 14M 204814 210278 OTHER IMPLANTS 70000590SCR SYN 3.5 16M 204816 133278 OTHER IMPLANTS 70000591SCR SYN 3.5 20M 204820 133278 OTHER IMPLANTS 70000592SCR SYN 3.5 26M 204826 195278 OTHER IMPLANTS 70000593SCR SYN 3.5 36M 204836 164278 OTHER IMPLANTS 70000594SCR SYN 4.0 18M 206018 110278 OTHER IMPLANTS 70000595SCR SYN 4.0 22M 206022 110278 OTHER IMPLANTS 70000596SCR SYN 4.0 30M 206030 110278 OTHER IMPLANTS 70000598NE 1/2 CIRCLE TAPER 2167 18272 STERILE SUPPLY 70000599TOURQ/CUFF 18STE.5921-21 71272 STERILE SUPPLY 70000601DEPUY VAPR S90 ELECT.225 1152272 STERILE SUPPLY 70000602GL PROTEXIS 7.5 LATEX FREE 6272 STERILE SUPPLY 70000603GL PROTEXIS 8.0 LATEX FREE 6272 STERILE SUPPLY 70000604AQUA.BIPO/SEALER 6.0 231 2397272 STERILE SUPPLY 70000605PREP CHLORA 3M ORNG 260 4272 STERILE SUPPLY 70000606APPLICATOR SEPP CHLORAPR 4272 STERILE SUPPLY 70000607PREP CHLORA 10.5M W/ORG 15272 STERILE SUPPLY 70000608PREP CHLORA 26M W/ORG.TI 28272 STERILE SUPPLY 70000609TUBE SALEM SUMP 14FR 264 5272 STERILE SUPPLY 70000610CATH FOLEY SIL 16FR 2657 8272 STERILE SUPPLY 70000611ANTI REFLUX VALVE 26619 18270 MED-SUR SUPPLIES 70000612PERI BOTTLE 82-231 8OZ 4272 STERILE SUPPLY 70000613SOFT ROLL 2 SYNTH MCMW0 4272 STERILE SUPPLY 70000614SOFT ROLL 6 SYNTH MCMW 7272 STERILE SUPPLY 70000616SLING ARM M AMBULITE 301 28270 MED-SUR SUPPLIES 70000617SLING ARM L PROCARE 79-8 28270 MED-SUR SUPPLIES 70000618SLING ARM XL PROCARE 79- 28270 MED-SUR SUPPLIES 70000623REB SUP SLING MED CSUS.3 202270 MED-SUR SUPPLIES 70000624REB SUP SLING LG CSUS 31 202270 MED-SUR SUPPLIES 70000625NE 21G 4 STIMUPLEX STIMA 51272 STERILE SUPPLY 70000626NE 22G 2 STIMUPLEX STIMA 38272 STERILE SUPPLY 70000627CAUT MEGA PENCIL EZ/CLE 21272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000631CANNULA NASAL SALTER W C 6272 STERILE SUPPLY 70000632DO NOT USE HOOD T4 STRYK SYSTEM 400 78270 MED-SUR SUPPLIES 70000633NE 18G 3.5 TOUHY 405018 14272 STERILE SUPPLY 70000634NE 18G 5 WEISS B-D 40519 34272 STERILE SUPPLY 70000635BO COMM SEMI-T 1014-14 8475278 OTHER IMPLANTS 70000637GLOVE RADI RES 8.5 XR498 120272 STERILE SUPPLY 70000638GEL PK/STER.SONOSITE 610 5272 STERILE SUPPLY 70000639PROBE COVER /SONOSITE 61 30272 STERILE SUPPLY 70000640CAN STK 20/100/5CR 40663 108272 STERILE SUPPLY 70000643CAUT PAD STRYK 40665020 24270 MED-SUR SUPPLIES 70000644GRAFT GELSOFT 8M FEM.673 3159278 OTHER IMPLANTS 70000645BL STK BO/MILL M/CUT 540 1160272 STERILE SUPPLY 70000646BL STK BO MILL F/CUT 540 1160272 STERILE SUPPLY 70000647IRRIG L-R 3000ML 782808 25272 STERILE SUPPLY 70000649ROD TSRH 3D 25X5.5 TI 83 993278 OTHER IMPLANTS 70000650SHORTS ORTHO BLUE XL 960 4270 MED-SUR SUPPLIES 70000651COLLAR ASPEN VISTA UNIVE 192274 PROSTHETIC DEVICES 70000657NE RX COUDE 18GX 3.5 105 76272 STERILE SUPPLY 70000665PEN SKIN MARKER MINI 145 4272 STERILE SUPPLY 70000666TISSEEL 4ML FROZEN 1501 991.4272 STERILE SUPPLY 70000667TISSEEL 10ML FROZEN 1501 2432.96272 STERILE SUPPLY 70000670VERSA-KATH 12' EPI. 156- 324272 STERILE SUPPLY 70000671BUR STRY 4M OVAL 1607- 250272 STERILE SUPPLY 70000672IM POWER PORT 8FR (BARD) 1632278 OTHER IMPLANTS 70000673ANES BIS SEN/XP QUATRO 1 77272 STERILE SUPPLY 70000677GLIDESCOPE GVL LG 0270-0 72270 MED-SUR SUPPLIES 70000678GLIDESCOPE GVL SM 0270-0 72270 MED-SUR SUPPLIES 70000679TRAY POWER PICC 5F DUAL/ 657272 STERILE SUPPLY 70000681GOWNS ISOLATION CS/100 13272 STERILE SUPPLY 70000682NE MEDTRONIC MARROW MAX 700272 STERILE SUPPLY 70000687KCI MED DRESG.M8275052-5 171272 STERILE SUPPLY 70000688KCI/CAN W/GEL M8275063/5 141272 STERILE SUPPLY 70000692COBE RESERVIOR ADPT HAR-A-1000 42272 STERILE SUPPLY 70000693COBE SAMP/SPIKE ADP 0070 20272 STERILE SUPPLY 70000694BL DYON 3.5 FULL RAD.720 209272 STERILE SUPPLY 70000695BL DYO FUL/RADIU 4.5 720 379272 STERILE SUPPLY 70000698BL DYO ACROMIONI 4M 7220 268272 STERILE SUPPLY 70000699BL DYO ACROMIONI 5.5 722 268272 STERILE SUPPLY 70000704MAT ABSORB/ CLOUD 9 (FOR 1710272 STERILE SUPPLY 70000706BO DANEK INFUSE 7510050 4625278 OTHER IMPLANTS 70000707BO DANEK INFUSE 7510100 8630278 OTHER IMPLANTS 70000708BO DANEK INFUS GRF 75102 16628278 OTHER IMPLANTS 70000709BO DANEK INFUS GRF 75104 23153278 OTHER IMPLANTS 70000710BO DANEK INFUS GRF 75106 25808278 OTHER IMPLANTS 70000711BO DANEK INFUS 7510800 27040278 OTHER IMPLANTS 70000712SCR TSRH 3D LOCKING 828 241278 OTHER IMPLANTS 70000713ROD TSRH 3-D 3CM 837003 566.2278 OTHER IMPLANTS 70000714ROD TSRH 3D 4M PREB 8370 773.5278 OTHER IMPLANTS 70000715ROD TSRH 3D 5M PREB 8370 708278 OTHER IMPLANTS 70000716ROD TSRH 3D 6M PREB 8370 708278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

70000717ROD TSRH 3D 7M PREB 8370 708278 OTHER IMPLANTS 70000718ROD TSRH 3D 8M PREB 837 1260.55278 OTHER IMPLANTS 70000719ROD TSRH 3D 9MM 8370090 450278 OTHER IMPLANTS 70000720ROD TSRH 3D 10M PREB 837 708278 OTHER IMPLANTS 70000721SCR TSRH 3D 5.5X45 83725 922278 OTHER IMPLANTS 70000722SCR TSRH 3D 5.5X50 83725 1152278 OTHER IMPLANTS 70000723SCR TSRH 3D 6.5 X 35 837 922278 OTHER IMPLANTS 70000724SCR TSRH 3D 6.5 X 40 837 922278 OTHER IMPLANTS 70000725SCR TSRH 3D 6.5X 45 837 922278 OTHER IMPLANTS 70000726SCR TSRH 3D 6.5 X 50 837 922278 OTHER IMPLANTS 70000727SCR TSRH 3D 6.5X55 83726 922278 OTHER IMPLANTS 70000728SCR TSRH 3D 7.5X35 83727 922278 OTHER IMPLANTS 70000729SCR TSRH 3D 7.5X40 83727 922278 OTHER IMPLANTS 70000730SCR TSRH 3D 7.5 X 45 837 922278 OTHER IMPLANTS 70000731SCR TSRH 3D 7.5 X 50 837 922278 OTHER IMPLANTS 70000732SCR TSRH 3D 7.5X55 83727 922278 OTHER IMPLANTS 70000733SCR TSRH 3D TBOLT S 8379 1983278 OTHER IMPLANTS 70000734SCR TSRH 3D TBOLT M 8379 2025278 OTHER IMPLANTS 70000735SCR TSRH 3D TBOLT L.8379 2060278 OTHER IMPLANTS 70000736JEL DERMA ECG DEFIB 3204 14270 MED-SUR SUPPLIES 70000737CUFF BP ADULT DATA RE-US 100270 MED-SUR SUPPLIES 70001211 HOOD STRYKER FLYTE PEEL LENSE 0408-801-5 173.2 272 STERILE SUPPLY 70001212CAN SYK VENOM 0406-630-115 27272 STERILE SUPPLY 70001213AIRPAL TRANSFER PAD SINGLE USE 34" x 78" 273272 STERILE SUPPLY 70001214NASAL CO2 SAMPLING LINE 6272 STERILE SUPPLY 70001215DR ODOR ANSEL MICRO TCH L 10 BOXES 4272 STERILE SUPPLY 70001216DR.ODOR NEOPRINE SIZE 8 4272 STERILE SUPPLY 70001217DR.ODOR DERMASSURE SIZE 8 4272 STERILE SUPPLY 70001218DR.ODOR NEU-THERA LATEX FREE SIZE 8 4272 STERILE SUPPLY 70001219DRAPE LARGE SHEET 72 X 85IN 8.84272 STERILE SUPPLY 70001220DRAPE LARGE SHEET 72 X 85IN 8.84272 STERILE SUPPLY 70001221DRAPE TABLE COVER 80 X 90IN 3.04272 STERILE SUPPLY 70001222PITCHER 120CC STERILE 8.06270 MED-SUR SUPPLIES 70001223INSTRUMENT POUCH 6.75 X 11.5IN 5272 STERILE SUPPLY 70001224PACK NEURO SUBSTITUTE SPP99MN7AA 130.64272 STERILE SUPPLY 70001225GOWN DR. ODOR X-LARGE 9.32270 MED-SUR SUPPLIES 70001226CAPNOLINE WITH O2 CONNECTOR 010209 46.8272 STERILE SUPPLY 70001227CAPNOLINE WITH O2 TUBING 53.36272 STERILE SUPPLY 70001228GOWN X-LG SUBSTITUTE 14272 STERILE SUPPLY 70001229BRONCHOSCOPE GLIDESCOPE SINGLE USE 1180270 MED-SUR SUPPLIES 70010001DRAIN THRORACENTISIS AK01000 175270 MED-SUR SUPPLIES 70010002SU VIC CT BRD 27" 2-0 5272 STERILE SUPPLY 70050524DRESSING BIOPATCH 2150 38272 STERILE SUPPLY 70050525ANSEL MICRO TOUCH NITRA FREE MEDIUM 4272 STERILE SUPPLY 80000060CATHETER SUCTION 10FR T6 4270 MED-SUR SUPPLIES 80000096 HOOD SURGEON 4380C 40270 MED-SUR SUPPLIES 80000129ELECTRODE TAB 3M 2360 10270 MED-SUR SUPPLIES 80000162AIRWAY 90MM BA1290 4270 MED-SUR SUPPLIES 80000163AIRWAY 80MM 412081 4270 MED-SUR SUPPLIES 80000164AIRWAY 100MM 2101 BOX/1 4270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80000165AIRWAY 60MM 312060 4270 MED-SUR SUPPLIES 80000173CONNECTOR TUBING 360 72270 MED-SUR SUPPLIES 80000184COVER TEMP PR GENIUS II 17270 MED-SUR SUPPLIES 80000192CUP DENTURE W/LID GREEN 4270 MED-SUR SUPPLIES 80000204CATHETER SUCTION 14FR T6 4270 MED-SUR SUPPLIES 80000225TUBING OXYGEN HUDSON 111 4270 MED-SUR SUPPLIES 80000249SOL BETADINE 8OZ 10% PRE 7270 MED-SUR SUPPLIES 80000335GLOVE RADI.RES 8.0 SSRI- 120272 STERILE SUPPLY 80000372GEL AQUASONIC 01-08 7270 MED-SUR SUPPLIES 80000409CPR MICROSHIELD MASK EA/ 27270 MED-SUR SUPPLIES 80000495GLOVE RADI.RES 8.5 RR1-8 120272 STERILE SUPPLY 80000530PL SYN BENDING TEMP.7H 3 108278 OTHER IMPLANTS 80000531PL SYN BENDING TEMP.9H 3 108278 OTHER IMPLANTS 80000600COVER PROBE ORAL KC20202 41270 MED-SUR SUPPLIES 80000690CUFF BP LG ADULT DATA RE 94270 MED-SUR SUPPLIES 80000740CHEST TUBE TROCAR 32FR. 61272 STERILE SUPPLY 80000741SPONGE 4X4 10/TR 7605 4272 STERILE SUPPLY 80000742CANNULA NASAL O2 001320 4270 MED-SUR SUPPLIES 80000743TUBE ET 7.0 5-10314 7272 STERILE SUPPLY 80000744IV CATH 16X1.25 RADPQ 30 7272 STERILE SUPPLY 80000745IV EXTENSION MX451-FL 4272 STERILE SUPPLY 80000747TAPE TRANSPORE 2CLEAR 15 4270 MED-SUR SUPPLIES 80000749TRAY SPI/25GA PORTEX 155 44272 STERILE SUPPLY 80000750TEMP STRIP DENOVO BX/100 4270 MED-SUR SUPPLIES 80000751NE EPI RX COUDE 6CR 1051 105272 STERILE SUPPLY 80000753IV BLOOD FILTER PALL SQ4 30272 STERILE SUPPLY 80000754ESOPHAGEAL/STETHO 18FR 7272 STERILE SUPPLY 80000755NE 18G 3.5 SPINAL B-D 40 5272 STERILE SUPPLY 80000757TUBING SUCTION 12' DC343 6272 STERILE SUPPLY 80000758OPTI-GARD 6135EP2500 19270 MED-SUR SUPPLIES 80000759SUCTION YANKAUER TIP K 4270 MED-SUR SUPPLIES 80000760KLEENEX FACIAL TISSUE 4270 MED-SUR SUPPLIES 80000761TUBING FLUID WARMING 242 38272 STERILE SUPPLY 80000762LIGACLIP COVIDEN RT.ANG 1435272 STERILE SUPPLY 80000764NE 20G 6 EPID TOUHY 183A 40270 MED-SUR SUPPLIES 80000765NE 22G X 7 SPINAL 405149 16270 MED-SUR SUPPLIES 80000766NE COAXIAL TEMNO BIOP. C 224270 MED-SUR SUPPLIES 80000767NE COAXIAL TEMNO BIOP CT 282270 MED-SUR SUPPLIES 80000768NE TEMNO COAXIAL BIOP CT 258270 MED-SUR SUPPLIES 80000770NE TEMNO COAXIAL BIOP CT 304270 MED-SUR SUPPLIES 80000771NE COAXIAL TEMNO BIOP. C 289270 MED-SUR SUPPLIES 80000772NE COAXIAL TEMNO BIOP CT 309270 MED-SUR SUPPLIES 80000773BONE BIOPSY SET (RADIOLO 532270 MED-SUR SUPPLIES 80000774BONE BIOPSY SET (RADIOLO 532270 MED-SUR SUPPLIES 80000775TRAY Z PASS /SHARPS 1145 9270 MED-SUR SUPPLIES 80000776IM DURA GUARD PATCH 6X8 2664278 OTHER IMPLANTS 80000777IV EXT T-PORT SMALL BORE 5270 MED-SUR SUPPLIES 80000779CHEST TUBE TROCAR 28FR 8 110270 MED-SUR SUPPLIES 80000781DRESSING NU-GAUZE PLAIN 7270 MED-SUR SUPPLIES 80000783SOFT ROLL 4" CAST PADDIN 4270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80000784SPONGE K'DIS ( PEANUT) D 7270 MED-SUR SUPPLIES 80000785CATH FOLEY18FR 3-WAY 017 34270 MED-SUR SUPPLIES 80000786CATHETER COUDE 18FR 5CC 42270 MED-SUR SUPPLIES 80000787CATHETER COUDE 20FR 5CC 42270 MED-SUR SUPPLIES 80000788CATHETER COUNCIL TIP 16F 51270 MED-SUR SUPPLIES 80000789CATHETER EMBOLECTOMY 3F 263270 MED-SUR SUPPLIES 80000790CATHETER EMBOLECTOMY 5F 258270 MED-SUR SUPPLIES 80000793GRAFT GELSOFT PATCH 6X3 1160278 OTHER IMPLANTS 80000794GRAFT GELSOFT 6M FEM/FEM 3159278 OTHER IMPLANTS 80000795GRAFT GELSOFT ST.7MM FEM 4000278 OTHER IMPLANTS 80000796CUFF BLOOD PRESSURE BARR 4270 MED-SUR SUPPLIES 80000797PILLOW DISPOSABLE 19 X 2 6270 MED-SUR SUPPLIES 80000798CLEAR MEDI-MUG LID STRAW 10270 MED-SUR SUPPLIES 80000801TUBE TRACH SHILEY 6DCT 178270 MED-SUR SUPPLIES 80000802TUBE SHILEY TRACH 8DCT 178270 MED-SUR SUPPLIES 80000803TUBE SHILEY TRACH 8LPC 238270 MED-SUR SUPPLIES 80000804PACK OB SET UP 29700 65270 MED-SUR SUPPLIES 80000805HEMOCLIP SMALL 523635 A 69270 MED-SUR SUPPLIES 80000806LIGHT HANDLES BLUE 5270 MED-SUR SUPPLIES 80000808BLANKET BAIR HUG TORSO 2 36270 MED-SUR SUPPLIES 80000811ELLECTRODE QUICK COMBO P 108270 MED-SUR SUPPLIES 80000812MICROINTRODUCER KIT 0678 264270 MED-SUR SUPPLIES 80000813TUBE VENT BLUE 4FT 1452 4270 MED-SUR SUPPLIES 80000814CATH TRACH / SUCTION 14F 25270 MED-SUR SUPPLIES 80000815VENTILATOR HUMID-VENT 1 5270 MED-SUR SUPPLIES 80000816CIRCUIT DISP. W/FILTER R 30270 MED-SUR SUPPLIES 80000818TRACH AEROSOL TEE C39-00 4270 MED-SUR SUPPLIES 80000819FILTER INSPIT BACT. DISP 19270 MED-SUR SUPPLIES 80000821DRILL BIT SYN 2.5 31025 504270 MED-SUR SUPPLIES 80000822DRILL BIT SYN 3.5 3103 504270 MED-SUR SUPPLIES 80000823K-WIRE SYN 1.25M X 150 2 218278 OTHER IMPLANTS 80000824K-WIRE SYN 1.25M X285M 2 22278 OTHER IMPLANTS 80000825K-WIRE SYN 2.0 X 150 29 218278 OTHER IMPLANTS 80000826PL SYN SM T OBLIQUE 241 600278 OTHER IMPLANTS 80000827PL SYN SM T OBLIQUE 241 640278 OTHER IMPLANTS 80000828PL SYN SM T OBLIQUE 241 660278 OTHER IMPLANTS 80000829PL SYN SM T RT ANG. 241 400278 OTHER IMPLANTS 80000830PL SYN SMT RT.ANG 24113 348278 OTHER IMPLANTS 80000831PL SYN 10 HOL TUBULAR 24 200278 OTHER IMPLANTS 80000832PL SYN 2 HOL TUBULAR 241 153278 OTHER IMPLANTS 80000833PL SYN 3 HOL TUBULAR 241 310278 OTHER IMPLANTS 80000834PL SYN 3 HOLE CLOVER 24 850278 OTHER IMPLANTS 80000835PL SYN 3.5 10 HO LCDCP 2 478278 OTHER IMPLANTS 80000836PL SYN 3.5 6 HOL LCDCP 2 413278 OTHER IMPLANTS 80000837PL SYN 3.5 7 HOL LCDCP 2 460278 OTHER IMPLANTS 80000838PL SYN 3.5 8 HOL LCDCP 2 453278 OTHER IMPLANTS 80000839PL SYN 3.5 9 HOL LCDCP 2 505278 OTHER IMPLANTS 80000840PL SYN 4 HOL TUBULAR 241 186278 OTHER IMPLANTS 80000841PL SYN 4 HOLE CLOVER 2 910278 OTHER IMPLANTS 80000842PL SYN 5 HOL TUBULAR 241 186278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80000843PL SYN 6 HOL TUBULAR 241 298278 OTHER IMPLANTS 80000844PL SYN 8 HOL TUBULAR 241 308278 OTHER IMPLANTS 80000845PL SYN 9 HLO TUBULAR 241 200278 OTHER IMPLANTS 80000846SCR SYN 3.5 10M 204810 164278 OTHER IMPLANTS 80000847SCR SYN 3.5 18M 204818 133278 OTHER IMPLANTS 80000848SCR SYN 3.5 22M 204822 195278 OTHER IMPLANTS 80000849SCR SYN 3.5 24M 204824 133278 OTHER IMPLANTS 80000850SCR SYN 3.5 28M 204828 195278 OTHER IMPLANTS 80000851SCR SYN 3.5 30M 204830 133278 OTHER IMPLANTS 80000852SCR SYN 3.5 32M 204832 79278 OTHER IMPLANTS 80000853SCR SYN 3.5 34M 204834 133278 OTHER IMPLANTS 80000854SCR SYN 3.5 38M 204838 133278 OTHER IMPLANTS 80000855SCR SYN 3.5 40M 204840 133278 OTHER IMPLANTS 80000856SCR SYN 3.5 45M 204845 133278 OTHER IMPLANTS 80000857SCR SYN 4.0 20M 207020 175278 OTHER IMPLANTS 80000858SCR SYN 4.0 30M 207030 56278 OTHER IMPLANTS 80000859SCR SYN 4.0 50M 207050 56278 OTHER IMPLANTS 80000860SCR SYN 4.0 X 32 206032 110278 OTHER IMPLANTS 80000861SCR SYN 4.0 X 36 206036 110278 OTHER IMPLANTS 80000862SCR SYN 4.0 10M 206010 175278 OTHER IMPLANTS 80000863SCR SYN 4.0 10M 207010 175278 OTHER IMPLANTS 80000864SCR SYN 4.0 12M 206012 110278 OTHER IMPLANTS 80000865SCR SYN 4.0 12M 207012 175278 OTHER IMPLANTS 80000866SCR SYN 4.0 14M 206014 175278 OTHER IMPLANTS 80000867SCR SYN 4.0 14M 207014 56278 OTHER IMPLANTS 80000868SCR SYN 4.0 16M 206016 110278 OTHER IMPLANTS 80000869SCR SYN 4.0 16M 207016 56278 OTHER IMPLANTS 80000870SCR SYN 4.0 18M 207018 56278 OTHER IMPLANTS 80000871SCR SYN 4.0 20M 206020 110278 OTHER IMPLANTS 80000872SCR SYN 4.0 22M 207022 175278 OTHER IMPLANTS 80000873SCR SYN 4.0 24M 207024 66278 OTHER IMPLANTS 80000874SCR SYN 4.0 24M 206024 110278 OTHER IMPLANTS 80000875SCR SYN 4.0 26M 207026 61278 OTHER IMPLANTS 80000876SCR SYN 4.0 26M 206026 66278 OTHER IMPLANTS 80000877SCR SYN 4.0 28M 207028 56278 OTHER IMPLANTS 80000878SCR SYN 4.0 28M 206028 110278 OTHER IMPLANTS 80000879SCR SYN 4.0 35M 207035 56278 OTHER IMPLANTS 80000880SCR SYN 4.0 35M 206035 110278 OTHER IMPLANTS 80000881SCR SYN 4.0 40M 207040 56278 OTHER IMPLANTS 80000882SCR SYN 4.0 40M 206040 110278 OTHER IMPLANTS 80000883SCR SYN 4.0 45M 207045 56278 OTHER IMPLANTS 80000884SCR SYN 4.0 45M 206045 110278 OTHER IMPLANTS 80000885SCR SYN 4.0 50M 206050 56278 OTHER IMPLANTS 80000886SCR SYN 4.0 55M 206055 175278 OTHER IMPLANTS 80000887SCR SYN 4.0 60M 206060 56278 OTHER IMPLANTS 80000888SCR SYN 50M 204850 68278 OTHER IMPLANTS 80000889SCR TSRH 3D OFFSET 83791 3230278 OTHER IMPLANTS 80000890SCR TSRH 3D 5.5X30 83725 1455278 OTHER IMPLANTS 80000891SCR TSRH 3D 5.5X35 83725 1510278 OTHER IMPLANTS 80000892SCR TSRH 3D 5.5X40 83725 1152278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80000893SCR TSRH 3D 6.5 X 60 837 1152278 OTHER IMPLANTS 80000894SCR TSRH 3D 6.5X30 83726 1777278 OTHER IMPLANTS 80000895SCR TSRH 3D 7.5 X 60 837 1152278 OTHER IMPLANTS 80000896SCR TSRH 3D 7.5X30 83727 1510278 OTHER IMPLANTS 80000897TAP SYN 3.5/CORTEX SCR 3 298278 OTHER IMPLANTS 80000898TAP SYN 4.0/CAN SCR 311 298278 OTHER IMPLANTS 80000900SU GOR CV-6 TTC13 6MO4 108270 MED-SUR SUPPLIES 80000907DRILL BIT SYN 2.7 31067 1832272 STERILE SUPPLY 80000908SCR SYN 4 0 34M LONG 207 840278 OTHER IMPLANTS 80000909SCR SYN 4.0 10M SHORT 20 840278 OTHER IMPLANTS 80000910SCR SYN 4.0 12M SHORT 20 630278 OTHER IMPLANTS 80000911SCR SYN 4.0 14M SHORT 20 630278 OTHER IMPLANTS 80000912SCR SYN 4.0 16M LONG 207 630278 OTHER IMPLANTS 80000913SCR SYN 4.0 16M SHORT 20 630278 OTHER IMPLANTS 80000914SCR SYN 4.0 18M LONG 20 630278 OTHER IMPLANTS 80000915SCR SYN 4.0 18M SHORT 20 630278 OTHER IMPLANTS 80000916SCR SYN 4.0 20M LONG 207 630278 OTHER IMPLANTS 80000917SCR SYN 4.0 20M SHORT 20 630278 OTHER IMPLANTS 80000918SCR SYN 4.0 22M LONG 207 630278 OTHER IMPLANTS 80000919SCR SYN 4.0 22M SHORT 20 630278 OTHER IMPLANTS 80000920SCR SYN 4.0 24M LONG 207 840278 OTHER IMPLANTS 80000921SCR SYN 4.0 24M SHORT 20 630278 OTHER IMPLANTS 80000922SCR SYN 4.0 26M LONG 207 840278 OTHER IMPLANTS 80000923SCR SYN 4.0 26M SHORT 20 630278 OTHER IMPLANTS 80000924SCR SYN 4.0 28M LONG 207 840278 OTHER IMPLANTS 80000925SCR SYN 4.0 28M SHORT 20 630278 OTHER IMPLANTS 80000926SCR SYN 4.0 30M LONG 207 840278 OTHER IMPLANTS 80000927SCR SYN 4.0 30M SHORT 20 630278 OTHER IMPLANTS 80000928SCR SYN 4.0 32M LONG 207 840278 OTHER IMPLANTS 80000929SCR SYN 4.0 32M SHORT 20 630278 OTHER IMPLANTS 80000930SCR SYN 4.0 34M SHORT 20 630278 OTHER IMPLANTS 80000931SCR SYN 4.0 36M LONG 207 840278 OTHER IMPLANTS 80000932SCR SYN 4.0 36M SHORT 20 720278 OTHER IMPLANTS 80000933SCR SYN 4.0 38M LONG 207 840278 OTHER IMPLANTS 80000934SCR SYN 4.0 38M SHORT 20 630278 OTHER IMPLANTS 80000935SCR SYN 4.0 40M LONG 207 840278 OTHER IMPLANTS 80000936SCR SYN 4.0 40M SHORT 20 1065278 OTHER IMPLANTS 80000937SCR SYN 4.0 42M SHORT 20 630278 OTHER IMPLANTS 80000938SCR SYN 4.0 44M LONG 207 840278 OTHER IMPLANTS 80000939SCR SYN 4.0 44M SHORT 20 630278 OTHER IMPLANTS 80000940SCR SYN 4.0 46M LONG 207 840278 OTHER IMPLANTS 80000941SCR SYN 4.0 46M SHORT 20 630278 OTHER IMPLANTS 80000942SCR SYN 4.0 48M LONG 207 840278 OTHER IMPLANTS 80000943SCR SYN 4.0 48M SHORT 20 630278 OTHER IMPLANTS 80000944SCR SYN 4.0 50M LONG 207 840278 OTHER IMPLANTS 80000945SCR SYN 4.0 50M SHORT 20 630278 OTHER IMPLANTS 80000946SRC SYN 4.0 42M LONG 20 840278 OTHER IMPLANTS 80000947TAP SYN CANN 4.0 31163 1455278 OTHER IMPLANTS 80000949CATH PVC TROCAR 20FR 842 49270 MED-SUR SUPPLIES 80000950KIT TROCAR CATH CHEST TU 378270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80000951DRAIN CHEST BLOOD DRY SU 567270 MED-SUR SUPPLIES 80000956CAUTERY BLADE 2.75 INSULATED 20056 23270 MED-SUR SUPPLIES 80000957CAUTERY BLADE 4" COATED 20013 31270 MED-SUR SUPPLIES 80000958CATHETER BRONCHO 39FR LE 289270 MED-SUR SUPPLIES 80000959SILVERLON 4X10 DRESSING ISLAND 107270 MED-SUR SUPPLIES 80000960SILVERLON 4X14 DRESSING ISLAND 179270 MED-SUR SUPPLIES 80000962BURR STRYKER3.2MM RASP C 411270 MED-SUR SUPPLIES 80000963BURR STRYKER 3.0MM AM8 411270 MED-SUR SUPPLIES 80000964BURR STR 3.0MM AM8 EXTEN 411270 MED-SUR SUPPLIES 80000965BURR STRYKER 2.5MM AM8 M 400270 MED-SUR SUPPLIES 80000966BURR STRYKER 1.7MM AM8 5 444272 STERILE SUPPLY 80000967BURR STRYKER 4.0MM STRAI 400270 MED-SUR SUPPLIES 80000968BURR STRYKER 4.0MM ROUND 400270 MED-SUR SUPPLIES 80000969BURR STRYKER 5.0MM ROUND 411270 MED-SUR SUPPLIES 80000970BURR STRYKER 6.0MM ACORN 411270 MED-SUR SUPPLIES 80000971BURR STRYKER 7.5X 7.9MM 411270 MED-SUR SUPPLIES 80000972BURR STRYKER 9.1X7.9MM F 527270 MED-SUR SUPPLIES 80000973BL STRYKER CASPAR 6MM 54 634272 STERILE SUPPLY 80000974BL STRYKER CASPAR 7MM 54 598272 STERILE SUPPLY 80000975BL STRYKER CASPAR 8MM 54 598272 STERILE SUPPLY 80000976BL STRYKER CASPAR 9MM 54 598272 STERILE SUPPLY 80000977BL STRYKER CASPAR 10MM 5 598272 STERILE SUPPLY 80000979BLADE STRYKER SAG SAW 22 148270 MED-SUR SUPPLIES 80000980SILVERLON 4X6 DRESSING ISLAND 54270 MED-SUR SUPPLIES 80000981PACK BASIC UNIVERSAL W/ 74270 MED-SUR SUPPLIES 80000982TRAY TRACH QUICK W/ADAPT 960270 MED-SUR SUPPLIES 80000983PROBE CADWELL DISP MONOP 190270 MED-SUR SUPPLIES 80000985SU SILK 3-0 KEITH K852H 6270 MED-SUR SUPPLIES 80000986SU PROLENE 6-0 RB2 30" 20270 MED-SUR SUPPLIES 80000987SU VIC 2-0 SH CR J775D 35270 MED-SUR SUPPLIES 80000988SU COTTONY 11 X-503 275270 MED-SUR SUPPLIES 80000989SU ETHIL 4-0 P-3 699H 11270 MED-SUR SUPPLIES 80000990SU PROLENE 5-0 24 8555 14270 MED-SUR SUPPLIES 80000991SU PROLENE 7-0 BV-1 8701 30270 MED-SUR SUPPLIES 80000995CATH EPIMED BREVI-XL 155 265270 MED-SUR SUPPLIES 80000996NE EPIMED 16 G CURVE 105 64270 MED-SUR SUPPLIES 80000997NE EPIMED 16G STRAIGHT 1 59270 MED-SUR SUPPLIES 80000998CPAP MASK LG ADULT FLOW 184270 MED-SUR SUPPLIES 80000999CPAP MASK LG ADULT FLOWS 224270 MED-SUR SUPPLIES 80001004SU VIC 3-30 CT1 J944H 40270 MED-SUR SUPPLIES 80001005SUCTION STRYKER NEPTUNE 107270 MED-SUR SUPPLIES 80001006SU 2-0 SILK 30" 623H 5270 MED-SUR SUPPLIES 80001007DRAIN JP FLAT 10MM SU130 20270 MED-SUR SUPPLIES 80001009GRAFT/ BARD PTFE FELT PL 95278 OTHER IMPLANTS 80001012CAN SYK VENOM 18/150MM/ 140270 MED-SUR SUPPLIES 80001013CAN SYK VENOM 20/100MM/ 140270 MED-SUR SUPPLIES 80001014CAN SYK VENOM 20/150MM/ 140270 MED-SUR SUPPLIES 80001018GRAFT GELSOFT 18X9 BIFUR 4350278 OTHER IMPLANTS 80001019GRAFT GELSOFT 20X20 BIFU 4350278 OTHER IMPLANTS 80001020CPAP FACE MASK LG RT040L 109270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80001021BO SP/GFT ORTHOBLEND DBM 5692.5278 OTHER IMPLANTS 80001022BO SP/GFT ORTHOBLEND DB 3500278 OTHER IMPLANTS 80001023NE IV ANGIOCATH 14 G X 5 51270 MED-SUR SUPPLIES 80001024SU ART FIBERWIRE 2 W/ N 192270 MED-SUR SUPPLIES 80001025QUEASE EASE SOOTHING SCE 22270 MED-SUR SUPPLIES 80001028NE PAJUNK SONOPLEX STIM 58270 MED-SUR SUPPLIES 80001029DRESSING DERMABOND PRINE 282270 MED-SUR SUPPLIES 80001030MASK O2 PEDIATRIC CONCEN 4270 MED-SUR SUPPLIES 80001031PIN MINI SPIKE DISPENSIN 4270 MED-SUR SUPPLIES 80001032ANES AIRTRAQ SP REGULAR 159.96270 MED-SUR SUPPLIES 80001033ANES AIRTRAQ SP SMALL SI 316270 MED-SUR SUPPLIES 80001036GL NEOPRENE PRO 8.5 NASR 5270 MED-SUR SUPPLIES 80001037SWIZEL TUBE TRACHEAL INTRODUCER 29270 MED-SUR SUPPLIES 80001038GL PROTEXIS CLASSIC 8 SZ 4270 MED-SUR SUPPLIES 80001039GL PROTEXIS CLASSIC 7.5 4270 MED-SUR SUPPLIES 80001040GL PROTEXIS CLASSIC 7 4270 MED-SUR SUPPLIES 80001041GL PROTEXIS CLASSIC 6.5 4270 MED-SUR SUPPLIES 80001042GL PROTEXIS CLASSIC 8.5 4270 MED-SUR SUPPLIES 80001045STRAP OR TABLE DISP SOUL 14270 MED-SUR SUPPLIES 80001046GL ENCORE ORTHO 6.5 4270 MED-SUR SUPPLIES 80001047GL ENCORE ORTHO 7 4270 MED-SUR SUPPLIES 80001048GL ENCORE ORTHO 7.5 4270 MED-SUR SUPPLIES 80001049GL ENCORE ORTHO SIZE 8 4270 MED-SUR SUPPLIES 80001050GL ENCORE ORTHO 8.5 4270 MED-SUR SUPPLIES 80001051CANN ARTHREX 7X7 AR-6570 100270 MED-SUR SUPPLIES 80001052GL PROTEXIS CLASSIC 9 4270 MED-SUR SUPPLIES 80001053GL ENCORE ORTHO 9 4270 MED-SUR SUPPLIES 80001054GL BLUE NEU THERA 7.5 2D 4270 MED-SUR SUPPLIES 80001055GL BLUE NEU THERA 7 2D72 4270 MED-SUR SUPPLIES 80001056GL BLUE NEU THERA 6.5 2D 4270 MED-SUR SUPPLIES 80001057GL BLUE NEU THERA 8.5 2D 4270 MED-SUR SUPPLIES 80001058GL BLUE NEU THERA 8 2D72 4270 MED-SUR SUPPLIES 80001059CATHETER SUCTION MINI TR 5270 MED-SUR SUPPLIES 80001060PROBE FRIENDSHIP MONOPOL 140270 MED-SUR SUPPLIES 80001061PROBE FRIENDSHIP BALL TI 168270 MED-SUR SUPPLIES 80001062CATH FOLEY 16FR 165816 N 13270 MED-SUR SUPPLIES 80001063TOURQ/ CUFF 18 X 5.5 2 B 116270 MED-SUR SUPPLIES 80001064TOURQ/CUFF 24 X 5.5 2 BL 129270 MED-SUR SUPPLIES 80001065SILVERLON 4X8 DRESSING ISLAND 89270 MED-SUR SUPPLIES 80001066KIT ARROWGARD MULTI LUMEN MA 541270 MED-SUR SUPPLIES 80001067GOWN BAIR PAW STANDARD S 40270 MED-SUR SUPPLIES 80001068GOWN BAIR PAWS X-LARGE S 56270 MED-SUR SUPPLIES 80001069NE 18G X 3.5" TUOHY 183A 28270 MED-SUR SUPPLIES 80001070NE 20G X 3.5 WEISS 40518 16270 MED-SUR SUPPLIES 80001071NE 18G X 6" TUOHY 183A02 54270 MED-SUR SUPPLIES 80001072BLADE STRYKER CASPER 11M 598270 MED-SUR SUPPLIES 80001073SUPPORT LUMBAR 4XL OC25- 98270 MED-SUR SUPPLIES 80001075KIT MAK MINI ACCESS MIDL 104270 MED-SUR SUPPLIES 80001076ARTHROCARE WAND SUPER TU 680270 MED-SUR SUPPLIES 80001080GL ORTHO SIZE 9 LATEX PO 4270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80001081SLIPPERS TERRY TREADS XL 4270 MED-SUR SUPPLIES 80001082CATH SPHENOCATH FLUORO B 400270 MED-SUR SUPPLIES 80001085CAN SYK ACTIVE TIP 15MM 108270 MED-SUR SUPPLIES 80001086HOT PACK MED 6X9" 1314C 4270 MED-SUR SUPPLIES 80001087KIT IRRISEPT IRRIGATION 248270 MED-SUR SUPPLIES 80001088CATH EPIDURAL NEO-KATH D 170270 MED-SUR SUPPLIES 80001089SUT ETHILON 664G 18" 2-0 7270 MED-SUR SUPPLIES 80001091CUFF GREEN REG ADULT DISPOSABL 10270 MED-SUR SUPPLIES 80001092CUFF GREEN LARGE ADULT DISPOSA 5270 MED-SUR SUPPLIES 80001096KIT MAK MINI ACCESS MAK5 76270 MED-SUR SUPPLIES 80001097SUTURE PASSER SMITH NEPH 348270 MED-SUR SUPPLIES 80001098CUFF GREEN SMALL DISPOSABLE 30 9270 MED-SUR SUPPLIES 80001099PENETRATION SET 9.5CM 10 528270 MED-SUR SUPPLIES 80001101SU CHROMIC 4-0 P-3 18" 23270 MED-SUR SUPPLIES 80001102SU CHROMIC 5-0 P-2 18" 1 24270 MED-SUR SUPPLIES 80001103SU 4-0 PLAIN GUT 18" 45C 12270 MED-SUR SUPPLIES 80001104MEROCEL DOYLE NASAL PACK 99270 MED-SUR SUPPLIES 80001105SUCTION CAUTERY COAGULAT 33270 MED-SUR SUPPLIES 80001106ELECTRODE 5SET PRASS PAI 532270 MED-SUR SUPPLIES 80001107PROBE SIDE BY SIDE BIPOL 531270 MED-SUR SUPPLIES 80001108DRAPE IOBAN 23 X 23 INCH 29270 MED-SUR SUPPLIES 80001109DRAPE LARGE TOWEL 17 X 2 4270 MED-SUR SUPPLIES 80001110DRAPE SURG FLOUROSCOPE 3 10270 MED-SUR SUPPLIES 80001111SU 2-0 SILK 8 X 18 INCH 30270 MED-SUR SUPPLIES 80001112SU 3-0 SILK 8 X 18 INCH 37270 MED-SUR SUPPLIES 80001113PROBE SIDE BY SIDE BIPOL 260270 MED-SUR SUPPLIES 80001114LIGHT HANDLES GREEN OR6 4270 MED-SUR SUPPLIES 80001115WAND COBLATOR PROCISE XP 1064270 MED-SUR SUPPLIES 80001116BLADE ENT INFERIOR TUBIN 866270 MED-SUR SUPPLIES 80001117MAD NASAL INTRANASAL MUC 23270 MED-SUR SUPPLIES 80001118VENTILATOR CIRCUIT 3FT L 28270 MED-SUR SUPPLIES 80001120GRAFT COOK BIODESIGN DUR 3100270 MED-SUR SUPPLIES 80001121DURAMATRIX ONLAY PLUS 1X1 1248.25278 OTHER IMPLANTS 80001122DURAMATRIX ONLAY PLUS 1X3 1826278 OTHER IMPLANTS 80001124KIT ARROWGARD DOUBLE-LUM 342.08270 MED-SUR SUPPLIES 80001125PREC THIN 2.5 X 0.38 X 1 149270 MED-SUR SUPPLIES 80001126RASP LARGE TEAR CROSS CU 507270 MED-SUR SUPPLIES 80001127PREC THIN 5.5 X 0.38 X 1 149270 MED-SUR SUPPLIES 80001128BUR 2.1MM SIDE CUTTING 1 270270 MED-SUR SUPPLIES 80001129MICRO DUAL CUT 5.5 X 0.2 206270 MED-SUR SUPPLIES 80001130SAFEDGE PRECISION THIN 6 149270 MED-SUR SUPPLIES 80001131RASP SMALL TEAR CROSS CU 507270 MED-SUR SUPPLIES 80001132CRUTCHES ADULT 77708A 41270 MED-SUR SUPPLIES 80001133DARCO SHOE WOMEN SMALL M 56270 MED-SUR SUPPLIES 80001134DARCO SHOE WOMEN MEDIUM 56270 MED-SUR SUPPLIES 80001135DARCO SHOE WOMEN LARGE M 56270 MED-SUR SUPPLIES 80001136DARCO SHOE WOMEN XLARGE 56270 MED-SUR SUPPLIES 80001137DARCO SHOE MEN SMALL MQM 56270 MED-SUR SUPPLIES 80001138DARCO SHOE MEN MEDIUM MQ 56270 MED-SUR SUPPLIES 80001139DARCO SHOE MEN LARGE MQM 56270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80001140TOURQ/ CUFF 34 X 4 1 BLA 93270 MED-SUR SUPPLIES 80001141TOURQ/ CUFF 44 X 4 1 BLA 101270 MED-SUR SUPPLIES 80001142TOURQ/ CUFF 34 X 4 2 BL 99270 MED-SUR SUPPLIES 80001143TOURQ/ CUFF 44 X 4 2 BLA 108270 MED-SUR SUPPLIES 80001144SU 2-0 SH ETHIBOND X833H 8270 MED-SUR SUPPLIES 80001145SU 3-0 SH ETHIBOND X425H 7270 MED-SUR SUPPLIES 80001149IRRIGATOR 0.9% SODIUM CH 12270 MED-SUR SUPPLIES 80001150CANNULA NASAL OMNILINE P 28.04270 MED-SUR SUPPLIES 80001151SPLINT ORTHO GLASS 4 INC 258270 MED-SUR SUPPLIES 80001154DRESSING ARTHREX JUMPSTA 76270 MED-SUR SUPPLIES 80001155SU 0 ETHIBOND MO-6 CX45D 43270 MED-SUR SUPPLIES 80001156VENTRALEX HERNIA PATCH S 2615270 MED-SUR SUPPLIES 80001157CAUTERY NEEDLE TIP 2.8 E 6270 MED-SUR SUPPLIES 80001164SU 0 ETHIBOND 8X18 CT-1 36270 MED-SUR SUPPLIES 80001165MESH PHS PROLENE HERNIA 2952.49278 OTHER IMPLANTS 80001166NE BONE BIOPSY MURPHY CO 440270 MED-SUR SUPPLIES 80001167NE SPINAL 25G X 5 405140 27270 MED-SUR SUPPLIES 80001169DRAIN PENROSE 1/4" 88885 4270 MED-SUR SUPPLIES 80001170GLOVE RADI RES 7.5 RR1-7 128270 MED-SUR SUPPLIES 80001171SU 5-0 CHROMIC GUT 18" P 21270 MED-SUR SUPPLIES 80001172CONNECTOR 1/4 STRAIGHT 3 71270 MED-SUR SUPPLIES 80001173TRAY CATH STRAIGHT 14FR 7270 MED-SUR SUPPLIES 80001174VENTRALEX HERNIA PATCH M 3132270 MED-SUR SUPPLIES 80001175MESH VENTRALEX ST HERNIA 4150278 OTHER IMPLANTS 80001176MESH VENTRALEX ST HERNIA 2950278 OTHER IMPLANTS 80001177MESH VENTRALEX ST HERNIA 3525278 OTHER IMPLANTS 80001178MESH BARD FLAT SHEET MAR 367278 OTHER IMPLANTS 80001179MESH HERNIA BARD MARLEX 649278 OTHER IMPLANTS 80001180EXTENSION SET 6IN SMALLB 9270 MED-SUR SUPPLIES 80001181BL STRYKER SAW 2296-3-11 118270 MED-SUR SUPPLIES 80001182NE EPIMED 20G 4.5" BLUNT 64270 MED-SUR SUPPLIES 80001183NE EPIMED 20G 6" BLUNT C 64270 MED-SUR SUPPLIES 80001184CAN SYK VENOM 18/100MM/ 140270 MED-SUR SUPPLIES 80001185EVICEL 5ML FIBRIN SEALEN 1803270 MED-SUR SUPPLIES 80001186EVICEL 2ML FIBRIN SEALAN 784270 MED-SUR SUPPLIES 80001187EVICEL 45CM FLEXIBLE TIP 89270 MED-SUR SUPPLIES 80001188SU 0 ETHIBOND 18" CT-2 C 36270 MED-SUR SUPPLIES 80001189NE 22G 1.5 SPINAL 405161 6270 MED-SUR SUPPLIES 80001190SU 2 ETHILON NYLON DOUBL 12270 MED-SUR SUPPLIES 80001191BURR 3MM PREC NEURO MATC 748270 MED-SUR SUPPLIES 80001192CANNULA THREADED FLEX 6. 148270 MED-SUR SUPPLIES 80001193CANNULA TREADED FLEX 8.0 148270 MED-SUR SUPPLIES 80001194BIOPSY FORCEPS RADIAL JA 415270 MED-SUR SUPPLIES 80001195GLOVE RADIATION 7.5 2087 122270 MED-SUR SUPPLIES 80001196IV EXT SET PRESSURE INJE 7270 MED-SUR SUPPLIES 80001197CATH N GLOVE 14FR NITRIL 27270 MED-SUR SUPPLIES 80001198MEDTRONIC GROUNDING PAD 15270 MED-SUR SUPPLIES 80001199CANNULA CURVED SHARP 5C 22G 60270 MED-SUR SUPPLIES 80001200CANNULA CURVED SHARP 10C 60270 MED-SUR SUPPLIES 80001201CANNULA CURVED SHARP 15C 12270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

80001202 ACCURIAN PROBE INTERNALLY COOLED APSC02 2480 270 MED-SUR SUPPLIES 80001203 ACCURIAN PROBE INTERNALLY COOLED APSC05 2480 270 MED-SUR SUPPLIES 80001204SENSOR STRAIGHT TIP NITI 348270 MED-SUR SUPPLIES 80001206IRRIG STR WATER 1000 713 16272 STERILE SUPPLY 80001207CANNULA CURVED SHARP 15CM 60270 MED-SUR SUPPLIES 80001208CANNULA CURVED BLUNT 22G 60270 MED-SUR SUPPLIES 80001209MAGNETIC INSTRUMENT MAT 10X 16 19.04270 MED-SUR SUPPLIES 80001210CUFF WHITE ADULT LONG DISP 2 CNECTR 10270 MED-SUR SUPPLIES 80001211DRAPE INTUBATION CLEAR 13.72272 STERILE SUPPLY 90050044SUPPORT LUMBAR SM OC25 91270 MED-SUR SUPPLIES 90050059SYR PISTON IRRIG 8272 STERILE SUPPLY 90050068MASK LMA SZ.3 1038030 520272 STERILE SUPPLY 90050069MASK LMA SZ.4 1038040 536272 STERILE SUPPLY 90050070MASK LMA SZ.5 105200-000050 400272 STERILE SUPPLY 90050071MASK LMA FAST TRACK# 3 4 1980272 STERILE SUPPLY 90050095GLOVE EUDERMIC 7.5 376 8272 STERILE SUPPLY 90050122HAEMONETICS SUCTION ASSEMBLY 0 140272 STERILE SUPPLY 90050124CATHETER RR 16FR 0094160 5272 STERILE SUPPLY 90050125CATHETER RR 18FR 0094180 5272 STERILE SUPPLY 90050142TRAY MYELOGRAM PHY 3405 49272 STERILE SUPPLY 90050165TRAY URIMETER W 16 FOLEY 56272 STERILE SUPPLY 90050166TRAY IRRIG PISTON 4272 STERILE SUPPLY 90050179DRAIN PENROSE 1X18 09180 4272 STERILE SUPPLY 90050193CPAP O2 LINE ADAPTER 4270 MED-SUR SUPPLIES 90050200SCR TSRH TI 6.5 X 50 82 922278 OTHER IMPLANTS 90050201SCR TSRH TI LOCKING 82 324278 OTHER IMPLANTS 90050202SCR TSRH TI T-BOLT S 828 1236278 OTHER IMPLANTS 90050203IV NS/HEP 1000U 500ML 76 11270 MED-SUR SUPPLIES 90050210DRILL BIT 3.0MM 14MM 324 616272 STERILE SUPPLY 90050224SCR TSRH TI 6.5 X 45 82 922278 OTHER IMPLANTS 90050225PL TSRH TI CROSSLINK 811 2000278 OTHER IMPLANTS 90050226BO SGT PLIF ICW 10X26 17 6250278 OTHER IMPLANTS 90050227MXR STICKER/ 2010 RED 62270 MED-SUR SUPPLIES 90050228SCR TSRH TI 7.5 X 50 82 2742278 OTHER IMPLANTS 90050232SCR TSRH TI 6.5 X 40 82 2742278 OTHER IMPLANTS 90050233SCR TSRH TI T-BOLT M 828 1311278 OTHER IMPLANTS 90050234PL TSRH TI CROSSLINK 811 2000278 OTHER IMPLANTS 90050235BO SGT ICW 8 X 26 17 6250278 OTHER IMPLANTS 90050236MED NEURO PIS/QAD/COM.38 6810278 OTHER IMPLANTS 90050241SU VIC 1 CT-1 36 J947H 6272 STERILE SUPPLY 90050247IM CATH ALGOLINE MEDTRON 1425278 OTHER IMPLANTS 90050250MED ITREL EZ PROG. 7434A 3900278 OTHER IMPLANTS 90050251BL BEAVER 6700 MINI BX/2 6272 STERILE SUPPLY 90050252SU SILK 0 CT1/CR K424H 6272 STERILE SUPPLY 90050253CATHETER PASSER 38CM.859 392272 STERILE SUPPLY 90050267DJO BACK PAD 11-0813-9- 75272 STERILE SUPPLY 90050273DRESSING COVER-ROLL 6 45 20272 STERILE SUPPLY 90050283COLLAR ASPEN ADULT REG 9 160274 PROSTHETIC DEVICES 90050284COLLAR ASPEN ADULT TALL 160274 PROSTHETIC DEVICES 90050286FILTER AIR HANDLER 16X16 16270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90050410TOURNIQUET YELLOW 28270 MED-SUR SUPPLIES 90050414RESP CIRCUIT IPPB 1560 8270 MED-SUR SUPPLIES 90050420PAIN TAGS STL1960 PAIN M 7270 MED-SUR SUPPLIES 90050427PIN ZI/SPI INVIZIA TEMP 475278 OTHER IMPLANTS 90050429CHEM ALBUMIN SLIDES 1988 68270 MED-SUR SUPPLIES 90050430CHEM ALK PHOS SLIDES 10 228270 MED-SUR SUPPLIES 90050475KIT THORACENTESIS AK0100 175272 STERILE SUPPLY 90050497IM ARTRX 4.5 PUS/LOC AR1 1800278 OTHER IMPLANTS 90050498IM ARTHX CKS SU/AN AR192 1150278 OTHER IMPLANTS 90050499SU VIC 3/0 CTX J772D 46272 STERILE SUPPLY 90050500BL SAW BONE GRAFT 9MM MD 609272 STERILE SUPPLY 90050501BL SAW BONE GRAFT 10M MD 609272 STERILE SUPPLY 90050504SU VIC 3-0 CTX CR J722D 39272 STERILE SUPPLY 90050527EBI SHOULDER PAD 2185D 180272 STERILE SUPPLY 90050528NE 22GX6IN SP/QUINCKE BE 17272 STERILE SUPPLY 90050529SCR ACUMED ACUTRAK 2 MIN 1875278 OTHER IMPLANTS 90050530DRAIN BLAKE 19FR 1/4TROC 162272 STERILE SUPPLY 90050534IM TITAN ALIF ENDO CONST 50500278 OTHER IMPLANTS 90050535IM ARTHX 5.5 BSL AR-2323 1775278 OTHER IMPLANTS 90050536IM NUTECH TLIF PEEK ALL 12500278 OTHER IMPLANTS 90050541SCR PIONEER ALP ALL SIZE 1250278 OTHER IMPLANTS 90050543PL PIONEER ALP ALL SIZES 10000278 OTHER IMPLANTS 90050544SCR AESCULAP BUTTRESS AL 1100278 OTHER IMPLANTS 90050546PL AESCULAP BUTTRESS ALL 4475278 OTHER IMPLANTS 90050564NE OSSEOFLEX 1.0 STEERAB 6800272 STERILE SUPPLY 90050565GUIDEWIRE THEK CORAL ALL 210272 STERILE SUPPLY 90050566KIT INDWELLING CATH 0295 395272 STERILE SUPPLY 90050611IV CATH 14X1.25 RADPQ 40 10272 STERILE SUPPLY 90050637PAIN TAGS CUSTOM STL1959 5270 MED-SUR SUPPLIES 90050651NEBULIZER ADAPTER 031-28 21272 STERILE SUPPLY 90050696PIN AES FIX.SPECTRUM FG3 296272 STERILE SUPPLY 90050703ROD SEQUOIA 3LEV ALL SZ 1500278 OTHER IMPLANTS 90050705IM AES SPECTRUM 1L CERV 6200278 OTHER IMPLANTS 90050706IM AES SPECTRUM 2L CERV 7750278 OTHER IMPLANTS 90050707IM AES SPECTRUM 3L CERV 9300278 OTHER IMPLANTS 90050708IM AES SPECTRUM 4L CERV 10850278 OTHER IMPLANTS 90050713PROBE BALL TIP SAFENERVE 572272 STERILE SUPPLY 90050716SCR ACUTRAK 37M ATF-37 1055278 OTHER IMPLANTS 90050717LINERS BABY CHANGING STA 167270 MED-SUR SUPPLIES 90050757MED NEURO RESUME TL 398 9310278 OTHER IMPLANTS 90050758IM MED LEAD ON POINT 398 9310278 OTHER IMPLANTS 90050771NEBULIZER PREFILL 500ML 11272 STERILE SUPPLY 90050810SU MONO 3-0 SH Y416 6272 STERILE SUPPLY 90050813**DO NOT USE** SORIN RESERVIOR/SUCTION 370272 STERILE SUPPLY 90050820CATH EMBOLEC/LAT/FR 4F A 259272 STERILE SUPPLY 90050821MANOMETER 35MM MX443 12272 STERILE SUPPLY 90050823SCR SYN ZERO-P 3.0 LOC A 1325278 OTHER IMPLANTS 90050824TUBE FEED/8F(NG)437 DOB 29272 STERILE SUPPLY 90050826IM STRK AVAITOR 1L CER C 6200278 OTHER IMPLANTS 90050827PL AES S4 ELE ADJ CR/CO 2000278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90050828BO SGT PROGENIX PUTTY 5C 3125278 OTHER IMPLANTS 90050837BO SGT PROGENIX PUTTY 10 5200278 OTHER IMPLANTS 90050838IM TITAN CERVICAL ALZ 12700278 OTHER IMPLANTS 90050839IM AESCULAP S4 TAB 2L LU 21000278 OTHER IMPLANTS 90050842SCD SLEEVE SMALL 5345 239270 MED-SUR SUPPLIES 90050845SCR CENT STALIF MIDLINE 500278 OTHER IMPLANTS 90050848BO NUTECH MED.CERVICAL A 3100278 OTHER IMPLANTS 90050860KCI WHITE FOAM DRESG M62 52272 STERILE SUPPLY 90050863CANN ARTX 8.25X7 EXPA AR 156272 STERILE SUPPLY 90050867SCR ALPH ZODIAC LUM.ALSZ 2760278 OTHER IMPLANTS 90050868ROD AES S4 ELE LUM ALL/S 975278 OTHER IMPLANTS 90050872SCR AES S4 ELE SET ALL S 250278 OTHER IMPLANTS 90050873NIPPLE PIPE FOR PM-3300 19270 MED-SUR SUPPLIES 90050877IM ZI/SPI INVIZIA CERVIC 6200278 OTHER IMPLANTS 90050878IM ZI/SPI INVIZIA CERVIC 7750278 OTHER IMPLANTS 90050879IM ZI/SPI INVIZIA CERVIC 9300278 OTHER IMPLANTS 90050880IM ZI/SPI INVIZIA CERVIC 10850278 OTHER IMPLANTS 90050881ARTHREX FIBERWIRE #5 AR- 100272 STERILE SUPPLY 90050891SU ARTHX#2 FIBERCHAIN AR 180272 STERILE SUPPLY 90050898DRILL BIT AES SPECTRUM A 691272 STERILE SUPPLY 90050899DRILL BIT AES S4 CERV AL 796272 STERILE SUPPLY 90050901CAUT PAD V LAB W/CORD E7 12270 MED-SUR SUPPLIES 90050905SCR NUTECH LUMBAR POLY A 3000278 OTHER IMPLANTS 90050906ROD LANX TULLURIDE MIS A 1470278 OTHER IMPLANTS 90050907SCR LANX SET TELUR MIS A 250278 OTHER IMPLANTS 90050908K-WIRE LANX TELLURIDE FL 236278 OTHER IMPLANTS 90050909NE LANX TELLURIDE JAMSHI 700272 STERILE SUPPLY 90050910SCR LANX TELLURIDE MIS A 6125278 OTHER IMPLANTS 90050911IV LR 1000ML 795309 4270 MED-SUR SUPPLIES 90050915MASK 02-LOCK VENTURI 815 10272 STERILE SUPPLY 90050918DRILL BIT ABC 2.7 OLD FJ 691272 STERILE SUPPLY 90050919PIN AESCULP FIXATION FJ8 296272 STERILE SUPPLY 90050921DRILL BIT AESCULP 2.7 FJ 616272 STERILE SUPPLY 90050922IM DURANGO PEEK ALIF ALS 18165278 OTHER IMPLANTS 90050923PL LANX DURANGO ALSZ 14070278 OTHER IMPLANTS 90050924SCR DURANGO FX/VA/RESCUE 1420278 OTHER IMPLANTS 90050925PL DURANGO COVER ALSZ 4585278 OTHER IMPLANTS 90050926IM CATH MED PERC KIT 85 425278 OTHER IMPLANTS 90050927MED CATH ACC/KIT 8540 125272 STERILE SUPPLY 90050928MED NEURO REFILL 8551 112272 STERILE SUPPLY 90050929KIT SUTURELESS PUMP CON 750278 OTHER IMPLANTS 90050930CATHETER PASSER MED 858 392272 STERILE SUPPLY 90050931CATH MED INTER PUMP SEG 2000278 OTHER IMPLANTS 90050933DURAPREP 3M 6ML 8635 10270 MED-SUR SUPPLIES 90050935MED INDURA INTRA CATH 87 3475272 STERILE SUPPLY 90050936CATH MED ASCENDA PUMP 87 5500278 OTHER IMPLANTS 90050937SU PROLENE 2-0 SH 30 883 8272 STERILE SUPPLY 90050938MED PERSONAL THERAPY MAN 3180270 MED-SUR SUPPLIES 90050941ENT SINUS CAT GUID/M GC0 1480272 STERILE SUPPLY 90050942GUIDE WIRE ACU .035 WS09 44272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90050943KIT DUAL MARKING PEN/ LA 10272 STERILE SUPPLY 90050945ROD GS MED MIS ALL SIZES 1470278 OTHER IMPLANTS 90050952BO OSTEO CAN/CRUSH 15C X 1760278 OTHER IMPLANTS 90050954BO ALPH DBM 5C PASE PUTT 2375278 OTHER IMPLANTS 90050955BO NUTECH MORSELIZED ALL 14250278 OTHER IMPLANTS 90050956LOCKS PULL TIGHT A10 4270 MED-SUR SUPPLIES 90050957BO STA/BIO DBM 1C PUT/MA 950278 OTHER IMPLANTS 90050958BO STA/BIO DBM .5CC PUT/ 675278 OTHER IMPLANTS 90050959BO STA/BIO DBM 10C PUT/M 6125278 OTHER IMPLANTS 90050960BO STA/BIO DBM 5C PUT/MA 4125278 OTHER IMPLANTS 90050963IM KYPHON BO/CEMT MIX C0 725278 OTHER IMPLANTS 90050964MASK LMA SZ 2.5 10125 860272 STERILE SUPPLY 90050966DRAPE U (ORTHO) 10150 33272 STERILE SUPPLY 90050973DRAPE ULTRA SOUND 20X28 13272 STERILE SUPPLY 90050974BO STA/BIO 15CC CANC/GRA 1625278 OTHER IMPLANTS 90050975CAUTERY PAD MEGADYNE 085 10272 STERILE SUPPLY 90050978BO MTF/SYN CONFORM CRV A 3000278 OTHER IMPLANTS 90050982MASK LMA FLEXIBLE SZ 4 1 1140272 STERILE SUPPLY 90050983IM NUTEC NUSHIELD 2X3 NS 4975278 OTHER IMPLANTS 90050986IM NUTEC NUSHIELD 4X4 NS 6250278 OTHER IMPLANTS 90050991IM THEK PEEK VU L-POD AL 12500278 OTHER IMPLANTS 90050992SCR EMI FANG BUTTRESS AL 1875278 OTHER IMPLANTS 90050993IM KYPHON X-STOP (IPD) A 17600278 OTHER IMPLANTS 90050994SCR ACUMED COR 4.0 50-65 405278 OTHER IMPLANTS 90050995DRILL BIT ACU 2.0 MSDC50 276272 STERILE SUPPLY 90050996SCR ACUMED COR 8M-45 3.5 405278 OTHER IMPLANTS 90050997DRILL BIT ACUMED QUICK 656272 STERILE SUPPLY 90050998PL ACUMED CLAVICAL MIDSH 6005278 OTHER IMPLANTS 90051013NE ARTHRX SCORPION AR-13 560272 STERILE SUPPLY 90051019IM THEK PEEK VU E POD-TL 12500278 OTHER IMPLANTS 90051022PL NUTECH 1 LEVEL ALP AL 11500278 OTHER IMPLANTS 90051023CIRCUIT DISP C-PAP 6' 4270 MED-SUR SUPPLIES 90051024SCR NUTECH ALP ALL SIZES 500278 OTHER IMPLANTS 90051025KIT KYPHON ADD/LEVEL KPT 10000272 STERILE SUPPLY 90051026KIT KYPHON 1 STEP KPT15 12560272 STERILE SUPPLY 90051028MASK LMA PROSEAL SZ 3 1 1020272 STERILE SUPPLY 90051029MASK LMA PROSEAL SZ 4 1 1020272 STERILE SUPPLY 90051030MASK LMA PROSEAL SZ 5 1 1020272 STERILE SUPPLY 90051031SCR GLOBUS TRANS LOC/CAP 1000278 OTHER IMPLANTS 90051032IM AES PEEK A-SPACE ALSZ 14250278 OTHER IMPLANTS 90051033SCR ACUTRAK 16.0M ATM-16 1351278 OTHER IMPLANTS 90051037STAR SLEEVE VELCO AR-16 380272 STERILE SUPPLY 90051038IM GO/TX PA VESELGARD PV 4210278 OTHER IMPLANTS 90051039SCR AES S4 POST CERV ALZ 3250278 OTHER IMPLANTS 90051040SCR AES S4 SET POS/CERV 500278 OTHER IMPLANTS 90051041ROD AES S4 PO CERV ALSZ 900278 OTHER IMPLANTS 90051044ARTH KIT BIO TENODESIS A 700270 MED-SUR SUPPLIES 90051045IM ANULEX XCLOSE TIS/REP 8475278 OTHER IMPLANTS 90051046IM ANULEX XCLOSE SPIN/ST 4975278 OTHER IMPLANTS 90051047BO MTF CCS LORDOT SPACER 3100278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051053CHEST TUBE TROCAR 20F DT 46272 STERILE SUPPLY 90051054SCR OMNIA CORAL LUM. ALS 4500278 OTHER IMPLANTS 90051055IM DEPUY EAGLE+1LV CEV C 6200278 OTHER IMPLANTS 90051056IM DEPUY EAGLE+2LV CEV C 7750278 OTHER IMPLANTS 90051057IM DEPUY EAGLE+3LV CEV C 9300278 OTHER IMPLANTS 90051058IM DEPUY EAGLE+4LV CEV C 10850278 OTHER IMPLANTS 90051059IM ARTHX 4.5 PUSHLC AR19 1850278 OTHER IMPLANTS 90051060IM ARTHX 3.5 PUSH/LO AR1 1700278 OTHER IMPLANTS 90051061IM ARTHREX SU/AN 3M 1934 1225278 OTHER IMPLANTS 90051062IM ARTHREX SU/AN AR1934B 1600278 OTHER IMPLANTS 90051063ROD GS MED 250/500MM 2500278 OTHER IMPLANTS 90051069IM ANULEX VERSACLOSE VC2 4975278 OTHER IMPLANTS 90051071DJO COLD THERAPY UNIT 11 288272 STERILE SUPPLY 90051072IM THEK MANTA RAY 2L CER 7750278 OTHER IMPLANTS 90051073IM THEK MANTA RAY 3L CER 9300278 OTHER IMPLANTS 90051075KIT SPINEVIEW STR DIS.SV 3400278 OTHER IMPLANTS 90051085MIXEVAC3 CEMENT MIXER 20 232272 STERILE SUPPLY 90051088IM THEK PEEK VU A-POD AL 31500278 OTHER IMPLANTS 90051089PL THEK/VUAPOD SPINPLATE 15250278 OTHER IMPLANTS 90051090BO VITOSS-BA 10CC 210215 6500278 OTHER IMPLANTS 90051091SCR ACUTRAK 2 MICRO ALSZ 1950278 OTHER IMPLANTS 90051092DRILL BIT ACUTRAK2 MINI 1532272 STERILE SUPPLY 90051093WASHER SYN 7.3 13M 219.9 188278 OTHER IMPLANTS 90051094SCR ALPH SET MIS/ILLIC.2 250278 OTHER IMPLANTS 90051104SCR NU/SPI BUTTRESS ALL 1875278 OTHER IMPLANTS 90051105KIT SPINEVIEW FLEX SV2 5000272 STERILE SUPPLY 90051106SCR ACUMED LOCK/ CORT 2. 520278 OTHER IMPLANTS 90051107IM ARTH 5.5 BIOCOMP.AR23 2185278 OTHER IMPLANTS 90051108IM ARTH 4.75 BIOSW AR232 1900278 OTHER IMPLANTS 90051111NE DEPUY ASPIRATOR 27612 1000272 STERILE SUPPLY 90051112TUBING TUR IRRIGATION 2C 26272 STERILE SUPPLY 90051113PL NUTECH CERVICAL 2L AL 4750278 OTHER IMPLANTS 90051114IM SPI/ELE 3LV CRV CONST 8370278 OTHER IMPLANTS 90051115BO PIONEER BIOACTIVE 3D 6300278 OTHER IMPLANTS 90051116BO PIONEER BIOACTIVE 3D 8500278 OTHER IMPLANTS 90051118IM SP/ELE SAPPHIRE 4 LEVEL CERVICAL 9765278 OTHER IMPLANTS 90051119PIN SP/ELE SAPPHIRE FIXA 296278 OTHER IMPLANTS 90051120SCR SP/ELE SAPPHIRE ALL 500278 OTHER IMPLANTS 90051121DRILL SP/ELE SAPPHIRE AL 691272 STERILE SUPPLY 90051122IM SP/ELE SAPPHIRE 1 LEVEL CERVICAL 5580278 OTHER IMPLANTS 90051123IM SP/ELE SAPPHIRE 2 LEVEL CERVICAL 6975278 OTHER IMPLANTS 90051124IM SP/ELE SAPPHIRE 3 LEVEL 8370278 OTHER IMPLANTS 90051126IM AESCULP S4 ELE.1L LUM 14000278 OTHER IMPLANTS 90051127IM AESCULP S4 ELE.2L LUM 21000278 OTHER IMPLANTS 90051128IM AESCULP S4 ELE.3L LUM 28000278 OTHER IMPLANTS 90051129CAN DORNOCH /TP-RC2800 112272 STERILE SUPPLY 90051130IM CONFIDENCE BO/CEMENT 5000278 OTHER IMPLANTS 90051131ADAPTER LUER CONF CEMENT 80270 MED-SUR SUPPLIES 90051132DRAIN STRK CBCII 2250289 487272 STERILE SUPPLY 90051133GUIDEWIRE SYN 1.25 900.7 121272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051142BO ORTHO ALLOQUENT CERV 3100278 OTHER IMPLANTS 90051144BO STA/BIO OVAT EXTRA LA 19000278 OTHER IMPLANTS 90051145SCR PARAM POLYAXIAL PH1 1400278 OTHER IMPLANTS 90051146BO STA/BIO OVAT SM W/MAT 4975278 OTHER IMPLANTS 90051147BO STA/BIO OVAT SM W/O M 3975278 OTHER IMPLANTS 90051150GLOVE BIOGEL 6 LF SKIN 7272 STERILE SUPPLY 90051151GLOVE BIOGEL 6.5 LF SKIN 7272 STERILE SUPPLY 90051152GLOVE BIOGEL 7 LF SKIN 7272 STERILE SUPPLY 90051153GLOVE BIOGEL 7.5 LF SKIN 7272 STERILE SUPPLY 90051154GLOVE BIOGEL 9.0 LF SKIN 7272 STERILE SUPPLY 90051155SCR ZI/SP SEQUOIA CL/TOP 250278 OTHER IMPLANTS 90051156IM ZI/SPI SEQUOIA 2LV CO 21000278 OTHER IMPLANTS 90051157IM ZI/SPI SEQUOIA 3LV CO 28000278 OTHER IMPLANTS 90051158ROD SEQUOIA 1LV ALSZ 750278 OTHER IMPLANTS 90051159SCR THEK LOC VU A POD AL 7625278 OTHER IMPLANTS 90051162IM INOV 1LV CERV CONSTRU 6200278 OTHER IMPLANTS 90051163PL INOV CR/LNK CONSTRUCT 2000278 OTHER IMPLANTS 90051164IM INOV.4LV LUM/LAM CONS 35000278 OTHER IMPLANTS 90051165PL AES SPECTRUM CERV ALL 4750278 OTHER IMPLANTS 90051166DRILL BIT ACUMED QUICK R 432272 STERILE SUPPLY 90051168ROD ZI/PERC PATHFINDER A 1125278 OTHER IMPLANTS 90051169SCR K2M CASPIN POST/CER 3250278 OTHER IMPLANTS 90051170SCR K2M CASPIN SET SCREW 500278 OTHER IMPLANTS 90051171KIT ACCESSORY REPAIR 355 1000272 STERILE SUPPLY 90051172TOURNIQUET W VELCRO 1806 73270 MED-SUR SUPPLIES 90051174MED ANTENNA EXTERNAL 370 320272 STERILE SUPPLY 90051175BO LANX CERVICAL LORDOTI 3100278 OTHER IMPLANTS 90051176IM MED PRIM RESTOR ADV 9 60520278 OTHER IMPLANTS 90051177IM MED ITREL 4 37703 38250278 OTHER IMPLANTS 90051178IM RESTORE 37711 69065278 OTHER IMPLANTS 90051179IM MED RESTORE ULTRA 37 79690278 OTHER IMPLANTS 90051180IM MED IPG RESTORE SEN 3 90000278 OTHER IMPLANTS 90051181MED PT PROGRAMMER 37743 4664278 OTHER IMPLANTS 90051182MED PT PROGRAMMER 37744 3900278 OTHER IMPLANTS 90051183MED PT PROGRAMMER 37746 3900278 OTHER IMPLANTS 90051184MED CHARGING SYSTEM 377 9368278 OTHER IMPLANTS 90051185MED CHARGING SYSTEM 3775 9368278 OTHER IMPLANTS 90051186GUIDE WIRE MOVABLE CORE 124272 STERILE SUPPLY 90051206ROD NU/SPI S LOC POST/CE 900278 OTHER IMPLANTS 90051207SCR CENTINAL STALIF CER 1000278 OTHER IMPLANTS 90051211SCR NU/SPI SET S LOC POS 500278 OTHER IMPLANTS 90051212IM SYN ANTEGRA 1LV CONST 27500278 OTHER IMPLANTS 90051213IM SYN ANTEGRA 2LV CONST 37105278 OTHER IMPLANTS 90051214BO AES PROSPACE ALIF ALS 14250278 OTHER IMPLANTS 90051215WASHER SYN 13M BUTRESS 4 128278 OTHER IMPLANTS 90051216BO OSTE MATX.2.5X10CM A4 10400278 OTHER IMPLANTS 90051217BO OSTE MATRX 2.5X5CM T4 6460278 OTHER IMPLANTS 90051220SCR NU/SPI S LOC POST/CE 3250278 OTHER IMPLANTS 90051226IM LANX SNOW CAP 1L CER 6200278 OTHER IMPLANTS 90051227IM LANX SNOW CAP 2L CER 7750278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051228IM LANX SNOW CAP 3L CER 9300278 OTHER IMPLANTS 90051229IM LANX SNOW CAP 4L CER 10850278 OTHER IMPLANTS 90051230BO OSTEO PASTE 10CC A450 4250278 OTHER IMPLANTS 90051231BO COMM ULNA/SEGMNT 1194 3250278 OTHER IMPLANTS 90051236BO ORTHO/CONST MINI PEEK 3100278 OTHER IMPLANTS 90051237IM SYN 1-LEV CONSTRUCT C 6200278 OTHER IMPLANTS 90051239IM FILTER ECLP VENA CAVA 6000278 OTHER IMPLANTS 90051240BO SGT PROGENIX PUTTY 1C 895278 OTHER IMPLANTS 90051241PL ALPHA ASPIDA 1L ALP 10000278 OTHER IMPLANTS 90051243SCR ALPH ASPIDA (ALP)ALS 1250278 OTHER IMPLANTS 90051245PIN ALPHATEC FIXATION 296272 STERILE SUPPLY 90051247MIDAS CUT/TOOL (OLD) AM- 656270 MED-SUR SUPPLIES 90051249ROD K2M CASPIN POS/CER A 900278 OTHER IMPLANTS 90051252MED NEURO ULTRA LUM/LAM 92500278 OTHER IMPLANTS 90051253IM SYN PRODISC INF/END A 27500278 OTHER IMPLANTS 90051254IM SYN PRODISC INLAY AL 4500278 OTHER IMPLANTS 90051255IM SYN PRODISC SUP/END A 27500278 OTHER IMPLANTS 90051256BO AESCULP DBM 10C GEL M 3500278 OTHER IMPLANTS 90051257BO AESCULP DBM 1C GEL ME 3500278 OTHER IMPLANTS 90051258PL GS MED CROSSLINK ALSZ 2000278 OTHER IMPLANTS 90051259ROD SEA NEWPORT MIS 35M/ 1470278 OTHER IMPLANTS 90051260HUMIDIFER CHAMBER RESMED 260270 MED-SUR SUPPLIES 90051265IM ALPHA TRES/LUXE 1L CE 5580278 OTHER IMPLANTS 90051266IM ALPHA TRES/LUXE 3L CE 8370278 OTHER IMPLANTS 90051267IM ALPHA TRES/LUXE 4L CE 9765278 OTHER IMPLANTS 90051268SCR ALPHA TRESTLE ST/SD 500278 OTHER IMPLANTS 90051269SCR GS LAT CONN OPEN/CLO 3000278 OTHER IMPLANTS 90051274IM ALPH ZODIAC 1L LUMBAR 14000278 OTHER IMPLANTS 90051275IM ALPH ZODIAC 2L LUMBAR 21000278 OTHER IMPLANTS 90051276IM ALPH ZODIAC 3L LUMBAR 28000278 OTHER IMPLANTS 90051277ROD ALPH ZODIAC LUM ALSZ 975278 OTHER IMPLANTS 90051278PL ALPH ZOD OFFSET/CONNE 3465278 OTHER IMPLANTS 90051279SCR ALPH MIS/ILLICO PEDI 4500278 OTHER IMPLANTS 90051280PL LANX ASPEN LOCK MIS A 12000278 OTHER IMPLANTS 90051281PL LANX ASPEN MIS ALSZ 18500278 OTHER IMPLANTS 90051283ROD ALPH DUL/DIA SOLONAS 2500278 OTHER IMPLANTS 90051284IM SLONAS CR/LINK BRIDGE 2000278 OTHER IMPLANTS 90051285PL ALPH ZOD PARALLEL ROD 3465278 OTHER IMPLANTS 90051286SCR ALPH CON CLO/OPEN AL 3000278 OTHER IMPLANTS 90051287PL ALPH SOLONAS CR/LNK A 2000278 OTHER IMPLANTS 90051288SCR ALPHATEC SOLONAS SET 500278 OTHER IMPLANTS 90051289SCR BIO VU/LOC 4X14 SD 6 750278 OTHER IMPLANTS 90051290SCR ALPH SOLONAS PO/CER 3250278 OTHER IMPLANTS 90051291SCR BIO VU/LOC 5X14 SD 6 750278 OTHER IMPLANTS 90051292IM AES ASPACE SIBD PEEK 36740278 OTHER IMPLANTS 90051293IM ALPH PEEK INTERBODY A 14250278 OTHER IMPLANTS 90051294IM ALPH NOVEL TLIF PEEK 12500278 OTHER IMPLANTS 90051295IM ALPH PEEK NOVEL CORPE 15000278 OTHER IMPLANTS 90051297MED NEURO PRIME DUAL PER 90000278 OTHER IMPLANTS 90051299MED NEURO ULTRA SURESCAN 87875278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051300MED NEURO ULTRA KIT BATT 80000278 OTHER IMPLANTS 90051301IM ALPH.PUREGEN OSTEOPRO 9945278 OTHER IMPLANTS 90051302IM ALPHA PROFUSE CHIPS 5 2083278 OTHER IMPLANTS 90051303BO ALP VIP PLIF EX LONG 6250278 OTHER IMPLANTS 90051309BO NUTEC NUFIX CORT/DOW 10625278 OTHER IMPLANTS 90051310SCR AES ASPACE ARCADIUS 1815278 OTHER IMPLANTS 90051314BO CORELINK CERV/CAGE AL 2480278 OTHER IMPLANTS 90051315BO PIONEER CORT SEG ALL 3000278 OTHER IMPLANTS 90051316DRILL BIT INVIZIA 700272 STERILE SUPPLY 90051317PIN ALPH TREST/LUXE FIX/ 296272 STERILE SUPPLY 90051319SU ARTH 2M FIB/TA 7 AR72 180272 STERILE SUPPLY 90051322IM ZI/SPI TRINITY 2LV CE 7750278 OTHER IMPLANTS 90051323IM ZI/SPI TRINITY 3LV CE 9300278 OTHER IMPLANTS 90051324IM ZI/SPI TRINITY 4LV CE 10850278 OTHER IMPLANTS 90051325NE ALPH TARGETING 320272 STERILE SUPPLY 90051326GUIDE WIRE ALPHATEC TROC 210272 STERILE SUPPLY 90051327SCR NUVASIVE DBR2 ALL S 6125278 OTHER IMPLANTS 90051328IM MED 1X4 POCKET ADAP 7 1940278 OTHER IMPLANTS 90051329IM MED 2X4 DUAL POC/AD 7 3880278 OTHER IMPLANTS 90051330GLOVE BIOGEL 8.5 ECLIPSE 5272 STERILE SUPPLY 90051331SCR LEG MAST CORTICAL AL 5000278 OTHER IMPLANTS 90051332SCR LEG/CANNULATED ALSZ 6630278 OTHER IMPLANTS 90051333SCR NUV FIX/VA SELF TAP 625278 OTHER IMPLANTS 90051334IM ZI/SPI CONSTRU ST360 17500278 OTHER IMPLANTS 90051335SCR NUV HALO ALL SZ 2085278 OTHER IMPLANTS 90051336PL NUV HALO ANT/LUM ALL 16575278 OTHER IMPLANTS 90051337MED ADHESIVE 080118 120272 STERILE SUPPLY 90051339IM PEEK STRK CEV SPACER 5035278 OTHER IMPLANTS 90051340PL BIO VU/LOC 18MM 8311 4750278 OTHER IMPLANTS 90051341PL BIO VULOC 3/LV 54M 83 5600278 OTHER IMPLANTS 90051347IM WR/MED GRFT JACKET 86 18440278 OTHER IMPLANTS 90051348SCR AES SPECTRUM CERV AL 500278 OTHER IMPLANTS 90051350ENT SINUS CAT GUID/S GC0 1480272 STERILE SUPPLY 90051356IM NUTEC SPINE 1L CERVIC 6200278 OTHER IMPLANTS 90051357IM NUTEC SPINE 2L CERVIC 7750278 OTHER IMPLANTS 90051358IM NUTEC SPINE 3L CERVIC 9300278 OTHER IMPLANTS 90051359IM NUTEC SPINE 1L LUMBAR 14000278 OTHER IMPLANTS 90051360IM NUTEC SPINE 2L LUMBAR 21000278 OTHER IMPLANTS 90051361IM NUTEC SPINE 3L LUMBAR 28000278 OTHER IMPLANTS 90051362IM NUTEC SPINE 4L LUMBAR 35000278 OTHER IMPLANTS 90051363IM NUTEC SPINE 5L LUMBAR 42000278 OTHER IMPLANTS 90051365DRESSING EZ STABILIZER 9 16272 STERILE SUPPLY 90051371IM AES ABC-2 2L CERV CON 7750278 OTHER IMPLANTS 90051378ANCHOR MED INJEX 97791 1100278 OTHER IMPLANTS 90051380BO TUTO PLIF EX LONG ALL 6250278 OTHER IMPLANTS 90051381KIT KYPHON(THORACIC) KPE 12560272 STERILE SUPPLY 90051382KIT KYPHON THORA/ADD KPE 10000272 STERILE SUPPLY 90051383IM ANULEX FIXATE LEAD TA 4475278 OTHER IMPLANTS 90051384BO NUMED CAN/CRUSH 60CC 3900278 OTHER IMPLANTS 90051385IM RX MED ENGUARD ALL SZ 4125278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051386BO NUTECH MORSELIZED ALL 4000278 OTHER IMPLANTS 90051395BO NUTECH MORSELIZED W/O MATRIX 12500278 OTHER IMPLANTS 90051404ROD SEA/SPI NEWPORT MIS 2940278 OTHER IMPLANTS 90051407IM BIO SPI/FU STEM 1013 29000278 OTHER IMPLANTS 90051410SCR DENALI LAT/OFF SET C 4500278 OTHER IMPLANTS 90051411ROD OMNIA CORAL LUM ALL 1470278 OTHER IMPLANTS 90051412DJO BIL HOSE 11-0674-9-0 72272 STERILE SUPPLY 90051413PL THEK CORAL CR/LNK ALS 2000278 OTHER IMPLANTS 90051415PL NEWPORT CROSSLINK ALL 2000278 OTHER IMPLANTS 90051416PIN SEA SONOMA TEMP/FIX 400278 OTHER IMPLANTS 90051417MED NEURO BUMPY ANC/TIT 600278 OTHER IMPLANTS 90051418SCR DENALI ALL SZ 2750278 OTHER IMPLANTS 90051419SCR DENALI ILIAC ALL SZ 4500278 OTHER IMPLANTS 90051420SCD COOLING FAN 7774190 120270 MED-SUR SUPPLIES 90051421SCR DENALI ATR SET 10110 300278 OTHER IMPLANTS 90051423IM THEK PEEK VU C-POD AL 3100278 OTHER IMPLANTS 90051424IM SEA SONOMA 2L CERV CO 7750278 OTHER IMPLANTS 90051425IM SEA SONOMA 1L CERV CO 6200278 OTHER IMPLANTS 90051426IM SEA SONOMA 3L CERV CO 9300278 OTHER IMPLANTS 90051427IM SEA SONOMA 4L CERV CO 10850278 OTHER IMPLANTS 90051428SCR NUTECH SET/ LOCKING 250278 OTHER IMPLANTS 90051429MASK LMA FLEXIBLE SZ 3 1 1400272 STERILE SUPPLY 90051430MASK LMA FLEXIBLE SZ 5 1 1140272 STERILE SUPPLY 90051431IM CAGE SP/WAVE EXPAN.ST 20000278 OTHER IMPLANTS 90051432ROD DENALI COBALT CHROME 4125278 OTHER IMPLANTS 90051433PL ALPH ZODIAC CR/LINK A 2000278 OTHER IMPLANTS 90051435IM BIO VERSA DI HU/HEAD 11040278 OTHER IMPLANTS 90051436IM BIO SHOUL STEM COMP A 27615278 OTHER IMPLANTS 90051437IM BIO SHO HU/RSAF HEAD 26285278 OTHER IMPLANTS 90051439BO NUTECH MEDICAL PLIF A 6250278 OTHER IMPLANTS 90051440BO PATELLAR WEDGE 4400278 OTHER IMPLANTS 90051441SCR ZI/SPI 4.2X12 070011 500278 OTHER IMPLANTS 90051442SCR ZI/SPI 4.2X14 070011 500278 OTHER IMPLANTS 90051443SCR ZI/SPI 4.2X16 070011 500278 OTHER IMPLANTS 90051444SCR ZI/SPI 4.2X18 070011 500278 OTHER IMPLANTS 90051445SCR ZI/SPI 4.6X12 070011 500278 OTHER IMPLANTS 90051446SCR ZI/SPI 4.6X14 070011 500278 OTHER IMPLANTS 90051447SCR ZI/SPI 4.6X16VA.0700 500278 OTHER IMPLANTS 90051448DR BIT WRIGHT MED.2.2 11 384272 STERILE SUPPLY 90051449SCR SEASPINE LOCKING CAP 2450278 OTHER IMPLANTS 90051450IM K2M CAYMAN AN/LUM 1LV 22000278 OTHER IMPLANTS 90051451IM K2M CAYMAN AN/LUM 2LV 37105278 OTHER IMPLANTS 90051452TUBE ET ENDOFLEX CUFFED 9272 STERILE SUPPLY 90051453IM ZI-SPI PEEKI ARDIS AL 12500278 OTHER IMPLANTS 90051455PL SEA/SPI CROSSLINK ALL 2000278 OTHER IMPLANTS 90051456PL SEA MALIBU CROSSLINK 1800278 OTHER IMPLANTS 90051457PL EMI FANG BUTTRESS ALS 4475278 OTHER IMPLANTS 90051461PIN THEKEN PL HOLDING 500278 OTHER IMPLANTS 90051462PL ALPH MIS/ILLICO CR/LI 2000278 OTHER IMPLANTS 90051469I-STAT CALIBRATION VERIF 180270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051475PL K2M CAYMAN BUTTRESS A 4475278 OTHER IMPLANTS 90051476IM BIOMET TIB/PL 67M 141 9600278 OTHER IMPLANTS 90051477IM BIOMET TIB/PL 71M 14 9600278 OTHER IMPLANTS 90051478IM BIOMET TIB/PL 75M 141 9070278 OTHER IMPLANTS 90051479IM BIOMET TIB/PL 79M 141 9600278 OTHER IMPLANTS 90051480IM BIOMET TIB/PL 83M 141 9600278 OTHER IMPLANTS 90051481IM BIOMET TIB/PL 87M 141 9600278 OTHER IMPLANTS 90051484IM CENTI/PEEK STALIF CER 12000278 OTHER IMPLANTS 90051491IM GLO TRAN END SPOOL W/ 2750278 OTHER IMPLANTS 90051492IM GLOBUS TRA/SPOOL LORD 2125278 OTHER IMPLANTS 90051493SCR GLOBUS TRANSITION SE 2125278 OTHER IMPLANTS 90051494SCR GLOBUS TRANSITION HA 6000278 OTHER IMPLANTS 90051495SCR ART BICOMPOSITE TEN 1575278 OTHER IMPLANTS 90051496IM SEA MAL/DAY 3L LUMBAR 28000278 OTHER IMPLANTS 90051497BIPOLAR BAYONET MED ANG 2896272 STERILE SUPPLY 90051498EVAC GLASS CONTAINER S99 162272 STERILE SUPPLY 90051501DRILL BIT TRINICA 070016 700272 STERILE SUPPLY 90051503BO SGT ICW 12 X 20 17 6250278 OTHER IMPLANTS 90051508IM SEASPINE LAMINAR HOOK 5002278 OTHER IMPLANTS 90051511IM BIO VANGURD FM/COM 57 16075278 OTHER IMPLANTS 90051512IM BIOMET FEM/CO 65M 183 16075278 OTHER IMPLANTS 90051513IM BIOMET FEMUR 67.5M 18 15035278 OTHER IMPLANTS 90051514IM BIOMET 70M RT FEMUR 1 16075278 OTHER IMPLANTS 90051515IM BIOMET CR FEMORAL ALL 16075278 OTHER IMPLANTS 90051516IM BIOMET 65MM FEMUR 183 16075278 OTHER IMPLANTS 90051517IM BIOMET 67.5 F/COMP 18 16075278 OTHER IMPLANTS 90051518IM BIOMET TIB/BEAR 10M 1 6075278 OTHER IMPLANTS 90051519IM BIOMET TIB/BEARING AL 6075278 OTHER IMPLANTS 90051520IM BIOMET TIB/BEAR 10M 1 6075278 OTHER IMPLANTS 90051521IM BIOMET TI/BEAR.10M 18 6075278 OTHER IMPLANTS 90051522SCR DEPUY EAGLE+ S/D ALS 625278 OTHER IMPLANTS 90051523IM BIOMET PATELLA ALL SZ 3550278 OTHER IMPLANTS 90051524SCR GLOBUS REVOLVE LOC C 500278 OTHER IMPLANTS 90051525ROD GLOBUS REVOLVE ALL S 1000278 OTHER IMPLANTS 90051527IM DEPUY CAGE BENGAL ALS 3100278 OTHER IMPLANTS 90051528PL ZI/SPI 83M 07001880 4400278 OTHER IMPLANTS 90051529PL ZI/SPI TRIN 86M 07001 4400278 OTHER IMPLANTS 90051531IM BIO VANTI/BEAR 189080 6075278 OTHER IMPLANTS 90051532IM BIOMET VAN TIB/BEA 18 9385278 OTHER IMPLANTS 90051533ROD AES DUAL DIAM 5 5/3 3500278 OTHER IMPLANTS 90051534IM ARTH SU/TAK FIBERWIR 1400278 OTHER IMPLANTS 90051538PL SEA SONOMA 4 LEVEL AL 5850278 OTHER IMPLANTS 90051541BIPOLAR FORCEP DISP 7201 133272 STERILE SUPPLY 90051542EBI KNEE PAD STERILE 20 180272 STERILE SUPPLY 90051543SCR SYN 7.3 CANN 16M 208 1560278 OTHER IMPLANTS 90051544IM DEP VERSALOK RC/AN 21 2055278 OTHER IMPLANTS 90051545NE 20G GRIPPER PORT-A-CA 23272 STERILE SUPPLY 90051547PL NUTECH SPI BUTTRESS A 4475278 OTHER IMPLANTS 90051548SCR THEK MANTA RAY ST/SD 625278 OTHER IMPLANTS 90051550IM DEP FASTIN 5.0 RC 222 1650278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051551IM DEPUY FASTIN RC W/O-C 1585278 OTHER IMPLANTS 90051552IM MEDICREA USA ILV LUM 14000278 OTHER IMPLANTS 90051553IM MEDICREA USA 2LV LUM 21000278 OTHER IMPLANTS 90051554IM MEDICREA USA 3LV LUM 28000278 OTHER IMPLANTS 90051555DEPUY MITEK VAPOR HOOK E 916272 STERILE SUPPLY 90051556SU DERMABOND SKIN/ADH DH 16.16272 STERILE SUPPLY 90051568IM ARTH BIO COMP AR2324 2100278 OTHER IMPLANTS 90051569SCR SEA SONOMA FX/VA ALS 500278 OTHER IMPLANTS 90051576BO TUTO PLIF 14M 0700246 6075278 OTHER IMPLANTS 90051578PL SP/ELE SAPPHIRE 1 LEV 4200278 OTHER IMPLANTS 90051579PL SP/ELE SAPPHIRE 2 LEV 4750278 OTHER IMPLANTS 90051580PL SAPPHIRE 3 LEV 4370278 OTHER IMPLANTS 90051581DO NOT USE CHLORA PREP BLD CULT 81272 STERILE SUPPLY 90051583INST.VERTEBRAL SPREADER 5100270 MED-SUR SUPPLIES 90051584SYNTHOSPLINT PRIMACAST 2 294270 MED-SUR SUPPLIES 90051585BO ALPHA FEM/RING(ALIF)A 14250278 OTHER IMPLANTS 90051586PLASTER SPLINT 4 X 15 45270 MED-SUR SUPPLIES 90051587IM K2M PYRENEES 1LV CERV 6200278 OTHER IMPLANTS 90051588IM K2M PYRENEES 2LV CERV 7750278 OTHER IMPLANTS 90051589IM K2M PYRENEES 3LV CERV 9300278 OTHER IMPLANTS 90051590ROD PARAMOUNT PH2 25M TO 2975278 OTHER IMPLANTS 90051591NE STRK VERTEPORT 10G 30 200272 STERILE SUPPLY 90051592DRILL BIT STYK 10G 3068 280272 STERILE SUPPLY 90051593BANDAGE PLASTER 3X3 ROLL 43270 MED-SUR SUPPLIES 90051594PLASTER ROLL 4 X 15 3073 64270 MED-SUR SUPPLIES 90051597BO STA/BIO OVAT LG W/MAT 16500278 OTHER IMPLANTS 90051598BO STA/BIO OVAT LG W/O M 14875278 OTHER IMPLANTS 90051599IM THEK CORDANT 2L CER C 7750278 OTHER IMPLANTS 90051600IM THEK CORDANT 4L CER C 10850278 OTHER IMPLANTS 90051602SCR THK TETHER FX/VA/RES 500278 OTHER IMPLANTS 90051603IM ZI/SPI SEQUOIA 1LV LU 14000278 OTHER IMPLANTS 90051605NE 20G 4 STIMUPLEX 33368 53272 STERILE SUPPLY 90051606PL ZI/SPI 22M 0700340001 4475278 OTHER IMPLANTS 90051607PL ZI/SPI 24M SLE 070034 4475278 OTHER IMPLANTS 90051608PL ZI/SPI 26M 07003400 4475278 OTHER IMPLANTS 90051609PL ZI/SPI 28M 070034000 4475278 OTHER IMPLANTS 90051610PL ZI/SPI 30M 070034000 4475278 OTHER IMPLANTS 90051611PL ZI/SPI 34M 0700340007 4475278 OTHER IMPLANTS 90051612PL ZI/SPI SEL 38M 070034 4600278 OTHER IMPLANTS 90051613PL ZI/SPI 40M 070034100 4600278 OTHER IMPLANTS 90051614PL ZI/SPI 42M 070034100 4600278 OTHER IMPLANTS 90051615PL ZI/SPI 44M SEL 070034 4600278 OTHER IMPLANTS 90051616PL ZI/SPI 46M 0700341005 4600278 OTHER IMPLANTS 90051617PL ZI/SPI 36M 07003410 4600278 OTHER IMPLANTS 90051618PL ZI/SPI 54M 070034200 4600278 OTHER IMPLANTS 90051619PL ZI/SPI 60M SEL 070034 4600278 OTHER IMPLANTS 90051620PL ZI/SPI 63M 07003420 4600278 OTHER IMPLANTS 90051621PL ZI/SPI 69M 070034200 4600278 OTHER IMPLANTS 90051622INST SCISSOR MAYO CR 6 288270 MED-SUR SUPPLIES 90051624MED NEURO PI/QUD ELET.34 3000278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051625MED NEURO LEAD 45CM 348 6810278 OTHER IMPLANTS 90051626BO TRINITY 5CC EVOLUTION 11250278 OTHER IMPLANTS 90051627BO TRINITY 10CC EVOLUTIO 19000278 OTHER IMPLANTS 90051628KIT ACCESSORY 3550-02 240278 OTHER IMPLANTS 90051629MED PILES NEEDL 355014 180272 STERILE SUPPLY 90051630KIT ACCESSORY REPAIR 355 200278 OTHER IMPLANTS 90051631MED NEURO ACCES 3550-2 1400272 STERILE SUPPLY 90051632MED NEURO ACCE/6TOUHY 35 220272 STERILE SUPPLY 90051633MED NEURO ACCESS PLUG 35 600278 OTHER IMPLANTS 90051634MED NEURO ACES SNAP LID 1176272 STERILE SUPPLY 90051635KIT ACCESSORY MED 3550- 360272 STERILE SUPPLY 90051636KIT ACCESS ANCHOR 3550 600278 OTHER IMPLANTS 90051637MED NEURO ACCES 355041 180272 STERILE SUPPLY 90051638KIT ACCESSORY 3550-63 300272 STERILE SUPPLY 90051639KIT ACCESSORY MED 3555-3 360272 STERILE SUPPLY 90051640IM CENT STALIF MIDLINE P 42500278 OTHER IMPLANTS 90051641PIN BIO STEINMAN 9 35361 208278 OTHER IMPLANTS 90051643KIT ACCESSORY 3655-38 560272 STERILE SUPPLY 90051647BL KNIFE DISP #10 BD 371 4272 STERILE SUPPLY 90051652MED NEURO LEAD 377760 11710278 OTHER IMPLANTS 90051653MED NEURO LEAD 377675 11710278 OTHER IMPLANTS 90051654MED NEURO LEAD 75CM 3777 11710278 OTHER IMPLANTS 90051655MED NEURO LEAD 377860 11710278 OTHER IMPLANTS 90051656KIT MED LEAD 3778-75 11710278 OTHER IMPLANTS 90051657BO OSTEO CR/SPACER ALL S 3100278 OTHER IMPLANTS 90051658IV ANGIOCATH 14G X 5.25 84272 STERILE SUPPLY 90051659BO SP/GRFT AN/RAMP 15M T 14250278 OTHER IMPLANTS 90051660MED NEURO LEAD 1 X 8 387 6810278 OTHER IMPLANTS 90051661MED TRIAL LEAD 1X8 3874 6810278 OTHER IMPLANTS 90051662MED TRIAL LEAD 1X8 3874- 6810278 OTHER IMPLANTS 90051663MED TRIAL LEAD 40CM 387 6810278 OTHER IMPLANTS 90051664MED TRIAL LEAD 60CM 3875 6810278 OTHER IMPLANTS 90051665MED NEURO PIS/QUAD + 388 7350278 OTHER IMPLANTS 90051666SYN ADJ/CLAMP FOR DRF 39 2500272 STERILE SUPPLY 90051667IM CABLE ZI/SP SONGER SI 1100278 OTHER IMPLANTS 90051669SCR NUTECH CERVICAL ALL 500278 OTHER IMPLANTS 90051670IM PEEK ZI/SPI VISTA ALL 3100278 OTHER IMPLANTS 90051671BO CEMENT BIO COBALT 402 635278 OTHER IMPLANTS 90051672IM BIOMENT G-HV BONE CEM 1210278 OTHER IMPLANTS 90051673BO CEM/COLBAL-G BIOMET 4 2115278 OTHER IMPLANTS 90051675KIT STRK DECOMP 617G 407 6000272 STERILE SUPPLY 90051676KIT STRY DECOM 917G 4072 7000272 STERILE SUPPLY 90051677KIT STRY DECOMP 615G 407 6000272 STERILE SUPPLY 90051678PL ZI/SPI CROS/LINK ALL 2000278 OTHER IMPLANTS 90051679BO PIONEER ALIF BIGFOOT 14250278 OTHER IMPLANTS 90051684SCR SYN BUTRES 6.5X25 41 202278 OTHER IMPLANTS 90051685SCR SYN BUTRES 6.5X30 41 223278 OTHER IMPLANTS 90051686SCR SYN BUTRES 6.5X35 41 223278 OTHER IMPLANTS 90051689BO MTF GRICILLUS 430300 6250278 OTHER IMPLANTS 90051690BO COMM ACHILLES TENDON 7000278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051691PL UNITY ORTHFX ALSZ 433 10000278 OTHER IMPLANTS 90051692PL UNITY ORTHOFX COVER A 3000278 OTHER IMPLANTS 90051694SCR UNITY ORTHX RESCUE A 500278 OTHER IMPLANTS 90051695SCR LANX 4M VA.SELF/TAP 625278 OTHER IMPLANTS 90051696PIN LANX TEMPORARY 320272 STERILE SUPPLY 90051699DRILL BIT LANX SNOWCAP A 886272 STERILE SUPPLY 90051700IM ORTHO FIREBIRD 1L LUM 14000278 OTHER IMPLANTS 90051701IM ORTHO FIREBIRD 2L LUM 21000278 OTHER IMPLANTS 90051703PL SYN ATB 1LV 37MM 449 21005278 OTHER IMPLANTS 90051704BO COMM FIB/SEGMENT 1007 3250278 OTHER IMPLANTS 90051705SCR SYN 4.0 X 14M 450 365278 OTHER IMPLANTS 90051706BO COMM RAD/SEGMENT 1174 3000278 OTHER IMPLANTS 90051707BO BIO 20C FINE/CRUSH 45 1650278 OTHER IMPLANTS 90051708BO BIO 30C CAN/CUBES 450 2365278 OTHER IMPLANTS 90051709BO BIO 15C CAN/CUBES 450 1300278 OTHER IMPLANTS 90051710BO COMM 15C FINE/CRUSH 1 1300278 OTHER IMPLANTS 90051711BO COMM 60C FINE/CRUSH 1 4095278 OTHER IMPLANTS 90051712BO BIO 20C CAN/CUBES 450 1650278 OTHER IMPLANTS 90051714BO BIO 20C CAN/POWDER 45 1650278 OTHER IMPLANTS 90051715BO BIO 15CC CRUSHED 4514 1300278 OTHER IMPLANTS 90051716BO BIO 30CC CRUSHED 45-1 2365278 OTHER IMPLANTS 90051717BO COMM 30C FINE/CRUSH 1 2365278 OTHER IMPLANTS 90051718IM GLOBUS TRANSI/SPACER 1625278 OTHER IMPLANTS 90051719BO SGT PREC/GRAF(ALL) 45 12825278 OTHER IMPLANTS 90051720IM GLOBUS TRANSI BUMPER 1625278 OTHER IMPLANTS 90051723BO BIO ALIF SPACR ALL S 14250278 OTHER IMPLANTS 90051724BO BIO 17M ALIF SPCER 45 14250278 OTHER IMPLANTS 90051725SCR UNITY ORTHFX ALSZ 500278 OTHER IMPLANTS 90051726IM SYN ZERO-P LORDIC CER 19330278 OTHER IMPLANTS 90051727INST LUM/SPAN SET/6 W/CA 715270 MED-SUR SUPPLIES 90051740IM PEEK PILAR ALIF ALL S 14250278 OTHER IMPLANTS 90051741PL SYN SM STAT 48M 48734 6380278 OTHER IMPLANTS 90051742SCR SYN ATB 5.5 30M 489 2395278 OTHER IMPLANTS 90051743PL COVER PILAR ALSZ 3000278 OTHER IMPLANTS 90051744IM PEEK PILAR SA ALL SZ 21250278 OTHER IMPLANTS 90051745KIT DIRECTIGEN STREP 256 14270 MED-SUR SUPPLIES 90051746SCR PILAR SA ALL SZ 500278 OTHER IMPLANTS 90051749SCR SEA SIERRA CAP/SET A 500278 OTHER IMPLANTS 90051753IM SEA SIERRA 3LV POST/C 28000278 OTHER IMPLANTS 90051754SCR SEA SIERRA ALL SIZES 3250278 OTHER IMPLANTS 90051757BL SA/SAW (BIOMET) 50609 234272 STERILE SUPPLY 90051758ROD SEA SIERRA PRECONT A 900278 OTHER IMPLANTS 90051759BO CEMENT STK PCD W/HV 5 1600278 OTHER IMPLANTS 90051765PL ORTHO CROSSLINK ALL S 2000278 OTHER IMPLANTS 90051766BO NUVA TRIAD LORDO CER 3100278 OTHER IMPLANTS 90051767SCR SEXTANT 6.5 X 40 757 7605278 OTHER IMPLANTS 90051769BRACE DROP FOOT 520270 MED-SUR SUPPLIES 90051771IM CABLE ZIM SONGER DBL 2255278 OTHER IMPLANTS 90051772ARTHX SU LASSO 45L AR606 640272 STERILE SUPPLY 90051773IM ALPHA TRES/LUXE 2L CE 6975278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051774IM ZI/SPI TMS CERV TANTA 4975278 OTHER IMPLANTS 90051777SCR SP/EL MERCURY LOC CA 250278 OTHER IMPLANTS 90051778SCR LANX ASPEN SET MIS A 2000278 OTHER IMPLANTS 90051779SCR ALPH ZOD ILIAC SET A 665278 OTHER IMPLANTS 90051780SCR SP/ELE MERCURY MIS A 4500278 OTHER IMPLANTS 90051781SCR ALPH ZODIAC ILIAC AL 3115278 OTHER IMPLANTS 90051782K-WIRE GLOBUS BLUNT/SHAR 236278 OTHER IMPLANTS 90051783ROD ALPHA SOLONAS CERV A 900278 OTHER IMPLANTS 90051784PIN GLOBUS CITADEL 16M 6 884278 OTHER IMPLANTS 90051786BO NUTECH NUCEL MATRIX 5 475278 OTHER IMPLANTS 90051787SCR ORTHFX ASENT SET POS 500278 OTHER IMPLANTS 90051788ROD ORTHOFX ASENT ALSZ 900278 OTHER IMPLANTS 90051789SCR ORTHFX ASENT ALSZ PO 3250278 OTHER IMPLANTS 90051790PIN TRINICA FIXA 070065 380278 OTHER IMPLANTS 90051791BO SGT FIBULA SEGMENT AL 3630278 OTHER IMPLANTS 90051792MED NEURO ULTRA W/ADPT 80000278 OTHER IMPLANTS 90051795IM NUV PEEK COROENT XL(L 21707278 OTHER IMPLANTS 90051796IM NUV PEEK COROENT XLWI 28783278 OTHER IMPLANTS 90051797IM NUV BRIGADE ALIF CONS 50500278 OTHER IMPLANTS 90051798PL ACUMED DIS/CLAVICAL A 7225278 OTHER IMPLANTS 90051799ANES INT TRACH MUCOSAL A 21272 STERILE SUPPLY 90051801PEG 10X10 (OPTION 1 FOR 75270 MED-SUR SUPPLIES 90051802KIT STYK IVAS SYSTEM 70 6000272 STERILE SUPPLY 90051803MXR PINK CODE LABLE C071 4270 MED-SUR SUPPLIES 90051804BO AES PROSPACE DBM PUTT 3500278 OTHER IMPLANTS 90051805BO AES PROSPACE DBM PUTT 5290278 OTHER IMPLANTS 90051806ROD NEXLINK 120M 724120 900278 OTHER IMPLANTS 90051807ROD ALPH MIS PR/BN ALSZ 1470278 OTHER IMPLANTS 90051808SCR NUV DBR2 LOC CAP 737 250278 OTHER IMPLANTS 90051809KIT ANS LTA 11 11272 STERILE SUPPLY 90051810KIT LOW PROFILE EXT 748 3475278 OTHER IMPLANTS 90051811BO AESCULP CESPACE CERV 3100278 OTHER IMPLANTS 90051812SCR LEG OSTEOGRIP ALL SZ 4800278 OTHER IMPLANTS 90051813SCR NUV XLP BOLT ALSZ 3505278 OTHER IMPLANTS 90051823GEAR HINGES 780057HD MAI 564270 MED-SUR SUPPLIES 90051824IV D5W/NS 1000 ML 794109 5270 MED-SUR SUPPLIES 90051825SCR SOVEREIGN BO SCREW A 500278 OTHER IMPLANTS 90051827BOTTLE WATER 4270 MED-SUR SUPPLIES 90051828DRILL BIT ACUMED QUICK R 356272 STERILE SUPPLY 90051830INST MED BAYONET BIPOLAR 984270 MED-SUR SUPPLIES 90051831BO SYN TR SPACER ALL SZ. 12500278 OTHER IMPLANTS 90051832SCR ZI/SPI 4.2X12 07008 500278 OTHER IMPLANTS 90051833SCR ZI/SPI 4.2X14 070081 500278 OTHER IMPLANTS 90051834PL TSRH TI CONNECTER 811 2468278 OTHER IMPLANTS 90051835PL TSRH TI CROSSLINK 811 2000278 OTHER IMPLANTS 90051836PL TSRH TI CROSSLINK 811 2000278 OTHER IMPLANTS 90051837PL TSRH TI CROSSLINK 811 2000278 OTHER IMPLANTS 90051838SCR ZI/SPI 4.2X12 070081 500278 OTHER IMPLANTS 90051839SCR ZI/SP 4.2X14 SD 0700 500278 OTHER IMPLANTS 90051840SCR ZI/SP VA/FIX SLF/DR 500278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051841IM PARAD STALIF W/OUT PE 35000278 OTHER IMPLANTS 90051842SCR BUTTRESS 30M 822230 945278 OTHER IMPLANTS 90051843SCR BUTTRESS 35MM 822235 1940278 OTHER IMPLANTS 90051844IM CABLE ATLAS TIT/DLB 8 2875278 OTHER IMPLANTS 90051845IM CABLE ATLAS TIT/SG 82 2250278 OTHER IMPLANTS 90051846SCR TSRH TI T-BOLT L 828 1311278 OTHER IMPLANTS 90051848SCR TSRH TI 5.5 X 45 82 2742278 OTHER IMPLANTS 90051849SCR TSRH TI 6.5 X 35 82 2742278 OTHER IMPLANTS 90051850SCR TSRH TI 7.5 X 35 82 2194278 OTHER IMPLANTS 90051851SCR TSRH TI 7.5 X 40 82 2742278 OTHER IMPLANTS 90051852SCR TSRH 3DX ALL SZ 922278 OTHER IMPLANTS 90051853SCR TSRH 3-D EXTENDER 83 525278 OTHER IMPLANTS 90051854MED PUMP SYNCHRO 20M 86 47600278 OTHER IMPLANTS 90051855MED PUMP SYNCHRO 40M 863 47600278 OTHER IMPLANTS 90051857ROD LEG 5.5 LONG/BLUE 86 1064278 OTHER IMPLANTS 90051858GUIDEWIRE UCSS THEAD 837 412272 STERILE SUPPLY 90051859DRILL BIT UCSS CANN ALS 2420272 STERILE SUPPLY 90051860GUIDEWIRE UCSS NONTHR 87 412272 STERILE SUPPLY 90051861SCR UCSS 42MM 873042 3170278 OTHER IMPLANTS 90051862SCR UCSS 44MM 873044 3170278 OTHER IMPLANTS 90051863PL ATLANTIS 27MM 876 3032278 OTHER IMPLANTS 90051864PL ATLANTIS 37.5MM 876 3032278 OTHER IMPLANTS 90051865PL ATLANTIS 47.5MM 876 3032278 OTHER IMPLANTS 90051866PL ATLANTIS 55MM 876 3032278 OTHER IMPLANTS 90051867SCR ATL VIS/VA FX SLF AL 792278 OTHER IMPLANTS 90051868IM NUTEC SPINE 7L LUM CO 56000278 OTHER IMPLANTS 90051869PL MED SPIRE Z ALL SIZES 14550278 OTHER IMPLANTS 90051870IM PERPOS SINGLE IMPL 90 10500278 OTHER IMPLANTS 90051871IM PERPOS PLS SYS 1 2 I 25000278 OTHER IMPLANTS 90051872PYRAMESH IM (CERV) CAGE 18300278 OTHER IMPLANTS 90051873IM COPPER HEAD PEEK CEV 3100278 OTHER IMPLANTS 90051874PAPER THERMAL/INTEL SYS 12270 MED-SUR SUPPLIES 90051876DRILL BIT SEA SONOMA ALS 288272 STERILE SUPPLY 90051877INST PROTECTORS GREEN 4270 MED-SUR SUPPLIES 90051878BO SP/GFT GRAF PASTE/PU 2500278 OTHER IMPLANTS 90051879BO OSTEO GEL/PASTE/PUTTY 750278 OTHER IMPLANTS 90051882DRILL BIT SEA SIERRA ALL 796272 STERILE SUPPLY 90051883ARTH ASPIR ABL 90D AR-97 1060272 STERILE SUPPLY 90051884PL ATL/VISION 21M 97612 3032278 OTHER IMPLANTS 90051885PL ATL VISION 23M 97612 3032278 OTHER IMPLANTS 90051886PL ATL VISION 25M 9761 3032278 OTHER IMPLANTS 90051887PL ATL/VISION 27.5 9761 3032278 OTHER IMPLANTS 90051888PL ATL/VISION 30M 97613 3032278 OTHER IMPLANTS 90051889PL ALT VISION 32.5M 9761 3111278 OTHER IMPLANTS 90051890PL ATL.VISION 35M 976135 3032278 OTHER IMPLANTS 90051891PL ATL VIS 37.5 976137 3032278 OTHER IMPLANTS 90051892PL ATL VISION 40M 97614 3032278 OTHER IMPLANTS 90051893PL ATL/VISON 42.5 97614 3032278 OTHER IMPLANTS 90051894PL ATL VISION 45M 97614 3032278 OTHER IMPLANTS 90051895PL ATL/VISION 47.5 9761 3032278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051896PL ATL VISION 50M 97615 3032278 OTHER IMPLANTS 90051897PL ATL VISION 52.5 9761 3032278 OTHER IMPLANTS 90051898PL ATL/VIS 55M 976155 3032278 OTHER IMPLANTS 90051899PL ATL VISION 57M 97615 3032278 OTHER IMPLANTS 90051900PL ATL VISION 60M 97616 3032278 OTHER IMPLANTS 90051901PL ATL/VISION 62.5 9761 3032278 OTHER IMPLANTS 90051902PL ATL/ VISION 65M 97616 3032278 OTHER IMPLANTS 90051903PL ATLANTIS 67.5 976167 3032278 OTHER IMPLANTS 90051904PL ATL/VISION 70M 9761 3032278 OTHER IMPLANTS 90051905PL ATL.VISION 72.5MM 976 3032278 OTHER IMPLANTS 90051906PL ATL/VISION 75M 976 3032278 OTHER IMPLANTS 90051907PL ATL VISION 85M 9761 3032278 OTHER IMPLANTS 90051908PAD ASPEN UNIV/REPLA 983 84270 MED-SUR SUPPLIES 90051909BO SPINALGRAFT AN/RAMP 1 14250278 OTHER IMPLANTS 90051911BO SP/GFT AN/RAMP 11M T8 14250278 OTHER IMPLANTS 90051912BO SP/GFT AN/RAMP 19M T8 14250278 OTHER IMPLANTS 90051913BO OSTEO AN/RAMP 21M 985 14250278 OTHER IMPLANTS 90051915NELLCOR CABLE PULSE OX M 458270 MED-SUR SUPPLIES 90051916KIT MED FACET INSTRUMENT 3000272 STERILE SUPPLY 90051917IM ANULEX FIXATE LEAD 2 8950278 OTHER IMPLANTS 90051918SPD TAG EASY TRACKING SC 4270 MED-SUR SUPPLIES 90051919ROD NUTECH LUMBAR CRVD T 750278 OTHER IMPLANTS 90051920PL TRINICA ALP ALL SZ 18763278 OTHER IMPLANTS 90051921CABLE 10' CAT 5 FOR N-39 54270 MED-SUR SUPPLIES 90051922ROD SEA/SPI COBALT CHROM 1000278 OTHER IMPLANTS 90051923CLIP NUVA.DYNAMIC LG ALS 1136272 STERILE SUPPLY 90051924SCR TRINIC ALP VA 070101 2453278 OTHER IMPLANTS 90051925SCR OMNIA CORAL LOCKING 450278 OTHER IMPLANTS 90051926SCR DENALI AXIAL ROD CON 4500278 OTHER IMPLANTS 90051929NE RX COUDE 14GX4 105131 176272 STERILE SUPPLY 90051930DO NOT USE MAYO STAND 21X16(PM) 1235270 MED-SUR SUPPLIES 90051931BO ZI/SPI PUROS A (ALIF) 14250278 OTHER IMPLANTS 90051933GUIDE WIRE GS MED 114011 210272 STERILE SUPPLY 90051934AIRWAY WILLIAMS (PINK) 1 15272 STERILE SUPPLY 90051935RESP BIPAP CIRCUT 53270 MED-SUR SUPPLIES 90051936IM BIO VERSA SHOULDER AD 1180278 OTHER IMPLANTS 90051937CABLE 3 LEAD SNAP PASSPO 480270 MED-SUR SUPPLIES 90051938SCR K2M CAYMAN BUTTRESS 1875278 OTHER IMPLANTS 90051939DATASCOPE ECG CABLE 3/5 468270 MED-SUR SUPPLIES 90051943MXR FILM TMG 9X9 151747 168270 MED-SUR SUPPLIES 90051944MXR FILM TMG 11X14 155 226270 MED-SUR SUPPLIES 90051945SCR THEK ATOLL POST CERV 2925278 OTHER IMPLANTS 90051946SCR THEK ATOLL LOCKING C 450278 OTHER IMPLANTS 90051947ROD THEK ATOLL POST CERV 810278 OTHER IMPLANTS 90051948DRILL THEK ATOLL POST/CE 288272 STERILE SUPPLY 90051949MXR FILM 14X36 TMG/RA3 1 8270 MED-SUR SUPPLIES 90051950MXR FILM T-MAT SCOLI 14X 291270 MED-SUR SUPPLIES 90051951LABLES DYMO PRINTER(VEN 4270 MED-SUR SUPPLIES 90051952CAN RF 18X145M PMF18-145 84272 STERILE SUPPLY 90051953IM BIO VAN TIB/BRNG ALL 9385278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90051954IM BIO KNEE TIB/BER EP18 10555278 OTHER IMPLANTS 90051955CUSTOM LUMBAR SPANNER SE 1400270 MED-SUR SUPPLIES 90051956SCR GLOB REVOLVE POST/LU 6500278 OTHER IMPLANTS 90051958SCR DEPUY EAGLE+RESCUE A 625278 OTHER IMPLANTS 90051959STEINMAN PIN 5/64 187-01 12278 OTHER IMPLANTS 90051960PL SEA SONOMA 2 LEVEL AL 4750278 OTHER IMPLANTS 90051961NUVASIVE STERILE PROBE 2 1044272 STERILE SUPPLY 90051962NE NUVASIVE I-PAS III 1100272 STERILE SUPPLY 90051963KIT NUVAS XLIF DISP 2029 2734272 STERILE SUPPLY 90051964CUFF DULB/ADULT ARM 30X4 1457270 MED-SUR SUPPLIES 90051965CUFF DLB ADULT THIGH 42X 1580270 MED-SUR SUPPLIES 90051967EBI NECK PAD 2030D 180272 STERILE SUPPLY 90051968CUFF SINGLE ADULT ARM 28 1180270 MED-SUR SUPPLIES 90051969CUFF SINGLE ADULT THIGH 1252270 MED-SUR SUPPLIES 90051970TOURNIQUETE 43 X 4 3/4 1999270 MED-SUR SUPPLIES 90051971PL K2M DENALI CR/LNK ALL 2000278 OTHER IMPLANTS 90051972SET INFUS W/INJ 22X.75 E 548270 MED-SUR SUPPLIES 90051973SCR MED FACET PERC ANCHO 18000278 OTHER IMPLANTS 90051974CAPSTONE PEEK CAGE MED 11250278 OTHER IMPLANTS 90051975IM PEEK CLYDESDALE ALL S 23750278 OTHER IMPLANTS 90051976IM PEEK CLYDESDALE (IF X 15000278 OTHER IMPLANTS 90051977RESP EQUIPMENT RENTAL 60270 MED-SUR SUPPLIES 90051978SCR NEWPORT LOCK/CAP ALL 250278 OTHER IMPLANTS 90051979SCR ZI/SPI MINIT CLOSE T 500278 OTHER IMPLANTS 90051980SCR ZI/SPI MINIT POST CE 3250278 OTHER IMPLANTS 90051981QUIK COMBO FOR DEFIB 130270 MED-SUR SUPPLIES 90051982SCR NEWPORT MIS ALL SIZE 4050278 OTHER IMPLANTS 90051983IM THEK TETHER 1L CER CO 6200278 OTHER IMPLANTS 90051984PL TETHER 1LV ALSZ CERV 4200278 OTHER IMPLANTS 90051985IM THEK TETHER 2L CER CO 7750278 OTHER IMPLANTS 90051986IM THEK TETHER 3L CER CO 9300278 OTHER IMPLANTS 90051987IM THEK TETHER 4L CER CO 10850278 OTHER IMPLANTS 90051988GUIDEWIRE NEWPORT BLUNT 210272 STERILE SUPPLY 90051990TRAY PICC LINE 4FR SING/ 560272 STERILE SUPPLY 90051991KIT NUVASIVE MAXCESS 324 5525272 STERILE SUPPLY 90051992KIT NUVASIVE DIS/SHIM 32 4600272 STERILE SUPPLY 90051993PIN TETHER FIX HOLD 03-2 296278 OTHER IMPLANTS 90051994BO LANX CERV CORT CANC A 3100278 OTHER IMPLANTS 90051995SCR PARAM POLYAXIAL PH3 1050278 OTHER IMPLANTS 90051996ROD SEQUOIA 2LV ALL SZ 1125278 OTHER IMPLANTS 90051997ROD NEWPORT W/LOCK CAP A 1720278 OTHER IMPLANTS 90051999MED NEURO EXTENSION 370 3405278 OTHER IMPLANTS 90052000MED NEURO EXT 40CM 3708 3895278 OTHER IMPLANTS 90052001MED NEURO EXT 60CM 370 3975278 OTHER IMPLANTS 90052002IM DYNESYS SPACER 010371 6360278 OTHER IMPLANTS 90052003IM DYNESYS CORD 100 0103 10640278 OTHER IMPLANTS 90052004SCR DYNESYS 6.4X50 10371 14715278 OTHER IMPLANTS 90052005ROD ZI/SPI MINIT POST CE 900278 OTHER IMPLANTS 90052006PIN SYNTHES RETAINER ALL 1100278 OTHER IMPLANTS 90052007MILLING BIT SYN 0382011 1768272 STERILE SUPPLY

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052008INSERTER TIP SYN 5 6 & 749272 STERILE SUPPLY 90052010MED SURG LEAD 2X8 39286- 30380278 OTHER IMPLANTS 90052011MED NEURO LEAD 39565-30 30380278 OTHER IMPLANTS 90052012KIT MED LEAD 39565-65 30380278 OTHER IMPLANTS 90052013TEST LUNG FOR VENT 00612 141270 MED-SUR SUPPLIES 90052014STERRAD BLK & RED RIBBON 196270 MED-SUR SUPPLIES 90052016PL SYN ATB 43M SAC 0410 21500278 OTHER IMPLANTS 90052017SCR SYN ATB 26MM 0420102 2395278 OTHER IMPLANTS 90052022BO COMM PAT/WEDGE 1167-1 3550278 OTHER IMPLANTS 90052023ROBE PATIENT DISP LG/XL 10270 MED-SUR SUPPLIES 90052025ROD MED SOLERA COBALT AL 1000278 OTHER IMPLANTS 90052026BO NUV OSTEO+1C MATX 501 2250278 OTHER IMPLANTS 90052027BO NUV OSTEO+5C MATX 501 10918278 OTHER IMPLANTS 90052028BO NUV OSTEO+10C MATX 50 14250278 OTHER IMPLANTS 90052029MXR STR/BUT MAILER 5030 204270 MED-SUR SUPPLIES 90052030MXR GREEN 2009 YEAR LABE 112270 MED-SUR SUPPLIES 90052032RESP FACE MASK BI-PAP 79270 MED-SUR SUPPLIES 90052033SCR LEG 4.5 X 20M 754445 2776278 OTHER IMPLANTS 90052034SCR LEG 4.5 X 25 7544452 2776278 OTHER IMPLANTS 90052035SCR LEG 4.5 X 30M 754445 2776278 OTHER IMPLANTS 90052036SCR LEG 4.5 X 40 7544454 2776278 OTHER IMPLANTS 90052037SCR LEGACY 4.5 X 45 7544 2776278 OTHER IMPLANTS 90052038SCR LEG 5.0 X 25 754450 2776278 OTHER IMPLANTS 90052039SCR LEG 5.0 X 30 754450 2776278 OTHER IMPLANTS 90052040SCR LEG 5.0 X 35 754450 2776278 OTHER IMPLANTS 90052041SCR LEG 5.0 X 40 754450 2776278 OTHER IMPLANTS 90052042SCR LEG 5.0 X 45 754450 2776278 OTHER IMPLANTS 90052043SCR LEG 5.0 X 50 754450 2750278 OTHER IMPLANTS 90052044SCR LEG 5.5 X 25 754455 2776278 OTHER IMPLANTS 90052045SCR LEG 5.5 X 30 754455 2776278 OTHER IMPLANTS 90052046SCR LEG 5.5 X 35 754455 2776278 OTHER IMPLANTS 90052047SCR LEG 5.5 X 40 7544554 2776278 OTHER IMPLANTS 90052048SCR LEG.5.5 X 50 754455 2750278 OTHER IMPLANTS 90052049SCR LEGACY 5.5 X 55 7544 2776278 OTHER IMPLANTS 90052050SCR LEGACY 6.5X 25 75446 3470278 OTHER IMPLANTS 90052051SCR LEGACY 6.5 X 30 7544 2776278 OTHER IMPLANTS 90052052SCR LEGACY 6.5 X 35 7544 2750278 OTHER IMPLANTS 90052053SCR LEG. 6.5 X 40 754465 2750278 OTHER IMPLANTS 90052054SCR LEGACY 6.5 X 45 7544 2750278 OTHER IMPLANTS 90052055SCR LEG 6.5X 50 7544655 2750278 OTHER IMPLANTS 90052056SCR LEG 6.5X 55 754465 2750278 OTHER IMPLANTS 90052057SCR LEG 6.5 X 60 7544656 2750278 OTHER IMPLANTS 90052058SCR LEG 7.5 X 35 754475 2776278 OTHER IMPLANTS 90052059SCR LEG 7.5 X 40 75447 2776278 OTHER IMPLANTS 90052060SCR LEG 7.5 X 45 754475 2776278 OTHER IMPLANTS 90052061SCR LEG. 7.5 X 50 75447 2750278 OTHER IMPLANTS 90052062SCR LEGACY 7.5 X 55 7544 2776278 OTHER IMPLANTS 90052063SCR LEGACY 7.5 X 60 7544 2776278 OTHER IMPLANTS 90052064SCR LEGACY 8.5 X 40 7544 2750278 OTHER IMPLANTS 90052065SCR LEGACY 8.5 X 45 7544 2750278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052066SCR LEGACY 8.5 X 50 7544 2776278 OTHER IMPLANTS 90052067SCR LEG 8.5 X 55 7544855 2776278 OTHER IMPLANTS 90052068SCR NUV COROENT VA.ALSZ 5975278 OTHER IMPLANTS 90052069SCR LEG/RED 4.5X50 7549 4165278 OTHER IMPLANTS 90052070SCR LEG REDU 6.5X45 7549 4165278 OTHER IMPLANTS 90052071SCR LEG REDUCTION ALL SI 4165278 OTHER IMPLANTS 90052072SOLERA SCR MED SET/LOCKING 450278 OTHER IMPLANTS 90052073IM STENT URETERAL LUBRI 835278 OTHER IMPLANTS 90052074SOLERA SCR MED LUMBAR ALL SIZES 3375278 OTHER IMPLANTS 90052075BO NUV TRIAD ALIF ALGRFT 14250278 OTHER IMPLANTS 90052080GUIDE WIRE SP/ELE MERCUR 210272 STERILE SUPPLY 90052081PL SP/ELE MERCURY CR/LIN 1800278 OTHER IMPLANTS 90052082SOLERA ROD MED CHROMOLY 6.0MM 1000278 OTHER IMPLANTS 90052083ROD TRSH 3DX 40MM AND DO 708278 OTHER IMPLANTS 90052084ROD TSRH 3DX 50MM AND UP 3032278 OTHER IMPLANTS 90052085ROD SP/ELE MERCURY ALSZ 1470278 OTHER IMPLANTS 90052086ROD SPINAL ELE MERCURY 4 2940278 OTHER IMPLANTS 90052087RESP FIL/AIR INTAKE FOR 43270 MED-SUR SUPPLIES 90052088COOLING FAN FILTER NELLC 194270 MED-SUR SUPPLIES 90052089IM NUV PEEK COROENT XLFW 39925278 OTHER IMPLANTS 90052090SCR NUV XCORE ENDCAP PAR 11475278 OTHER IMPLANTS 90052091ROD ALPH COBALT CHROM AL 975278 OTHER IMPLANTS 90052092NE GLOBUS JAMSHIDI 62310 720272 STERILE SUPPLY 90052093KCI MED DRES SILVER M827 276272 STERILE SUPPLY 90052094IM PEEK COR CENTER STRUT 12975278 OTHER IMPLANTS 90052095IM PEEK CORNERSTONE PSR 7000278 OTHER IMPLANTS 90052096IM MED BRYAN CERV DISC A 28125278 OTHER IMPLANTS 90052097DRILL MED BRYAN DISC BIT 980272 STERILE SUPPLY 90052098BL MED BRYAN CUTTER ALL 2520272 STERILE SUPPLY 90052099IM NUTECH VAULT ALIF CON 29050278 OTHER IMPLANTS 90052101IM ALPH PUREGEN OSTEOPRO 3222278 OTHER IMPLANTS 90052102IM ALPH PUREGEN OSTEOPRO 16734278 OTHER IMPLANTS 90052103IM ALPHA PROFUSE CHIPS 1 583278 OTHER IMPLANTS 90052104IM ALPHA PROFUSE CHIPS 1 3358278 OTHER IMPLANTS 90052105STERIS ACID SPRAYER(AUTO 271270 MED-SUR SUPPLIES 90052106IM NUV PEEK COROENT CER 3100278 OTHER IMPLANTS 90052107IM NUV PEEK COROENT LW A 16000278 OTHER IMPLANTS 90052108IM NUV PEEK COROENT TLIF 12500278 OTHER IMPLANTS 90052109ROD VERTEX 240MM 69002 900278 OTHER IMPLANTS 90052110SCR VERTEX SET SCREW 690 500278 OTHER IMPLANTS 90052111VERTEX SCR MAX SET SCREW 500278 OTHER IMPLANTS 90052112DRILL BIT VERTEX MAX 695 864272 STERILE SUPPLY 90052113SCR VERTX SEL 3.5X12 695 3250278 OTHER IMPLANTS 90052114SCR VERTX SEL 3.5X14 695 3250278 OTHER IMPLANTS 90052115SCR VERTEX MAX 3.5X16 69 3250278 OTHER IMPLANTS 90052116SCR VERTEX MAX 3.5X18 69 3250278 OTHER IMPLANTS 90052117SCR VERTEX MAX ALL SIZES 3250278 OTHER IMPLANTS 90052118SCR VERTX MAX 4.X 26 695 3250278 OTHER IMPLANTS 90052119SCR VERTEX MAX 4X32M 695 3250278 OTHER IMPLANTS 90052120VERTEX SCR SELECT ALL SIZE 3250278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052121DRILL BIT PRESTIGE 69612 1180272 STERILE SUPPLY 90052122IM PRESTIGE CERV DISC AL 22250278 OTHER IMPLANTS 90052123PL VERTEX CR/LK POS/CER 2000278 OTHER IMPLANTS 90052124SCR LEG OFF SET CONN ALS 1800278 OTHER IMPLANTS 90052125SCR LEG ILIAC BOLT ALL S 3850278 OTHER IMPLANTS 90052126SCR LEG ILIAC SET ALL SZ 450278 OTHER IMPLANTS 90052127DRILL BIT VISION 70805 500272 STERILE SUPPLY 90052128PIN ATL/VIS FIX/HOLD 708 620278 OTHER IMPLANTS 90052132PL ALP TRES/LUX CERV 2 L 4750278 OTHER IMPLANTS 90052134INST COBB ELEV 25MM 400270 MED-SUR SUPPLIES 90052135HAEMONETICS BOWL SET CSE-P-125 340272 STERILE SUPPLY 90052136SCR NUV X-CORE ENDCAP LO 1225278 OTHER IMPLANTS 90052137IM NUV XCORE CAGE CORPC 51725278 OTHER IMPLANTS 90052138BULB DYONICS LIGHT SOURC 2664270 MED-SUR SUPPLIES 90052139ORATEC VULCAN CHISEL 720 501272 STERILE SUPPLY 90052140ORATEC VULCAN 30DG 7209 527272 STERILE SUPPLY 90052141ORATEC VULCAN 90DG 7209 527272 STERILE SUPPLY 90052142CAN SN 15C 20X10 S/CR 72 68272 STERILE SUPPLY 90052143ROD NUVASIVE DBR2 ALL SI 1470278 OTHER IMPLANTS 90052144CAUT PAD ELECTR S/N 7220 28270 MED-SUR SUPPLIES 90052145IM SN FOOTPRINT RO/CUFF 1400278 OTHER IMPLANTS 90052146SCR NUV SPHERX LOCK SCRE 250278 OTHER IMPLANTS 90052147PL NU SHERX 2 ADJ CR/LNK 2000278 OTHER IMPLANTS 90052148PL NUV SPHERX CROSS/LNK 2000278 OTHER IMPLANTS 90052152SCR NUV SPHERX 2 POLYAX 3000278 OTHER IMPLANTS 90052153K-WIRE NUVASIVE 727010 210278 OTHER IMPLANTS 90052154ROD NUV SPHERX ALL SIZES 750278 OTHER IMPLANTS 90052155BO SP/GFT MAGNI PL 10CM 17000278 OTHER IMPLANTS 90052156BO SPINALGRAFT MAGNI PL 11750278 OTHER IMPLANTS 90052157BO SGT MAGNIFUSE 1X10 75 11700278 OTHER IMPLANTS 90052161SCR NUV XLP LOCK NUTS AL 755278 OTHER IMPLANTS 90052162PL NUV EXTREAM LATERAL A 16405278 OTHER IMPLANTS 90052163SCR LEG/SET 5.5 ALLSZ 75 250278 OTHER IMPLANTS 90052164SCR LEG/REDU/SET 5.5 754 508278 OTHER IMPLANTS 90052165SCR LEG 5.5 X 45 754455 2776278 OTHER IMPLANTS 90052166SCR LEG RED SPONDY 5.5X5 4165278 OTHER IMPLANTS 90052167SCR NUV EXTREME LATERAL 3505278 OTHER IMPLANTS 90052168SCR SEXTANT SET ALSZ 757 337278 OTHER IMPLANTS 90052169ROD LEG 70M LONGITUDE 75 2155278 OTHER IMPLANTS 90052170SCR SEXTANT 5.5 X 45 757 7605278 OTHER IMPLANTS 90052171SCR SEXTANT 6.5 X 35 757 7605278 OTHER IMPLANTS 90052172SCR SEXTANT 6.5 X 45 757 6625278 OTHER IMPLANTS 90052173BO MAS/GRFT GRAN/5C 7600 1350278 OTHER IMPLANTS 90052174BO MAS/GRFT GRAN/10C 760 2500278 OTHER IMPLANTS 90052175BO MAS/GRF 10C MATRX 760 4250278 OTHER IMPLANTS 90052176BO MAS/GRF 20C MATRX 760 5000278 OTHER IMPLANTS 90052178VERTEX ROD SELECT ALL SZ 900278 OTHER IMPLANTS 90052179PL MED VERTEX DOMINO CON 3085278 OTHER IMPLANTS 90052180SCR MED OCCIPITAL CORTIC 2180278 OTHER IMPLANTS 90052181ROD MED VERTEX THREAD 3 2855278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052182ROD MED VERTEX THREAD 5 3730278 OTHER IMPLANTS 90052183ROD MED CHROMOLY PRECURV 900278 OTHER IMPLANTS 90052184PL MED OCCIPITAL LRG ADJ 24500278 OTHER IMPLANTS 90052185DRILL BIT VERTEX SELEC 2 864272 STERILE SUPPLY 90052186IM VERTEX OFF/CONNECT AL 3085278 OTHER IMPLANTS 90052187DRILL BIT OCCIPATE ALL S 864272 STERILE SUPPLY 90052189SCR NUV SPHRX LOCK SCR/C 250278 OTHER IMPLANTS 90052191ROD NUV SPHRX PR/BENT MI 1470278 OTHER IMPLANTS 90052192BO MATRIX MED 10X20 7800 5000278 OTHER IMPLANTS 90052193IM SYN CHRONO BETA/TCP S 4425278 OTHER IMPLANTS 90052194PL NUV TRAVERSE TWO BOLT 31240278 OTHER IMPLANTS 90052195SCR NUV TRAVERSE LOCK NU 1040278 OTHER IMPLANTS 90052196SCR NUV TRAVERSE BOLT AL 4770278 OTHER IMPLANTS 90052197IM NUV PEEK COROENT XLF 35670278 OTHER IMPLANTS 90052198IM SOVERIGN SPACER/COVPL 43000278 OTHER IMPLANTS 90052199PAPER BLADDER SCANER THE 6270 MED-SUR SUPPLIES 90052200NE NUV ELECT SURFACE MOD 3697272 STERILE SUPPLY 90052201STYLET GLIDESCOPE (FOR O 1400270 MED-SUR SUPPLIES 90052202KEYBOARD TRAY (JIM) 668270 MED-SUR SUPPLIES 90052203PAPER DEFIB LIFE PAK 302270 MED-SUR SUPPLIES 90052204MXR FILM DUP/10X12 26899 307270 MED-SUR SUPPLIES 90052205PL TRSH X10 CROSLINK 811 2000278 OTHER IMPLANTS 90052206PL TSRH CR/LINK X10 ALSZ 2000278 OTHER IMPLANTS 90052207PL TSRH X10 CROSLINK 811 2000278 OTHER IMPLANTS 90052208PL TSRH X10 CROSLINK 811 2000278 OTHER IMPLANTS 90052209PL TSRH X10 CROSLINK 811 1800278 OTHER IMPLANTS 90052210KCI WOUND VAC RENTAL MAC 614.16270 MED-SUR SUPPLIES 90052211SCR TSRH 3DX SET 83515 241278 OTHER IMPLANTS 90052212SCR TSRH 3DX SM CON 8351 1983278 OTHER IMPLANTS 90052213SCR TSRH 3DX LRG CON 835 2060278 OTHER IMPLANTS 90052214SCR TSRH 3DX MED CON 835 2025278 OTHER IMPLANTS 90052215ROD TSRH 3D 35M PREB 837 708278 OTHER IMPLANTS 90052216ROD TSRH 3D 4.5M PREB 83 708278 OTHER IMPLANTS 90052217SCR TSRH 3D 8.5 X 50 837 922278 OTHER IMPLANTS 90052219GUIDE WIRE SEX/BLUNT 867 220272 STERILE SUPPLY 90052220GUIDE WIRE SEX/SHARP 867 220272 STERILE SUPPLY 90052221GUIDE WIRE MED DLIF ALL 220272 STERILE SUPPLY 90052222NE MED PAK KIT TROCAR 86 772272 STERILE SUPPLY 90052223SCR SEXTANT LOCKING 867 850278 OTHER IMPLANTS 90052224ROD SEXTANT 35M 8672035 2155278 OTHER IMPLANTS 90052225ROD SEXTANT 45M P/B 8672 2155278 OTHER IMPLANTS 90052226ROD SEXTANT 50M P/B 8672 2155278 OTHER IMPLANTS 90052227ROD SEXTANT 55MM 867205 2350278 OTHER IMPLANTS 90052228ROD SEXTANT 80MM 867208 2155278 OTHER IMPLANTS 90052229ROD SEXTANT 85MM 8672085 2155278 OTHER IMPLANTS 90052230SCR SEXTANT 5.5 X 40 867 7605278 OTHER IMPLANTS 90052231ROD LEG 5.5 COBALT 8690 2750278 OTHER IMPLANTS 90052232ROD LEG PRE/BN 30MM 8690 774278 OTHER IMPLANTS 90052233ROD LEG PR/BNT 40MM 869 450278 OTHER IMPLANTS 90052234ROD LEG 5.0CM PR/BNT 869 450278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052235ROD LEG 60MM 8690060 450278 OTHER IMPLANTS 90052236ROD LEG 5.5 70M PR/BN 86 450278 OTHER IMPLANTS 90052237ROD LEGACY 5.5 80M 8690 450278 OTHER IMPLANTS 90052238ROD LEGACY 90M 8690090 450278 OTHER IMPLANTS 90052240SCR ZEPHIR 3.5(ALL SZ) 738278 OTHER IMPLANTS 90052241SCR ZEPHIR 4.0(ALL SZ) 892278 OTHER IMPLANTS 90052242PIN ZEPHIR FIX PIN 8796 464278 OTHER IMPLANTS 90052243PL ZEPHIR (1LEV)ALL SZ 3200278 OTHER IMPLANTS 90052244PL ZEPHIR 2 LEVEL AND UP 3532278 OTHER IMPLANTS 90052245NE PIONEER BONE MARROW B 400272 STERILE SUPPLY 90052246BO PIONEER BONE VOID FIL 8500278 OTHER IMPLANTS 90052247IM CAGE PYRAMESH (LUM)AL 29450278 OTHER IMPLANTS 90052248WASHER 15M BUTTRESS 9090 1319278 OTHER IMPLANTS 90052249WASHER 17M BUTTRESS 9090 1319278 OTHER IMPLANTS 90052250IM PEEK CRESCENT ALL SZ 12500278 OTHER IMPLANTS 90052251ROD INCOMP ALL 3LV (90M 1500278 OTHER IMPLANTS 90052252PL SPIRE SPINOUS ALL SIZ 14550278 OTHER IMPLANTS 90052253SCR SPIRE SET (DANAK)924 450278 OTHER IMPLANTS 90052255PROBE NIM BALL TIP 9450 708272 STERILE SUPPLY 90052256NE MED PEDI/AC PROBE 945 2380272 STERILE SUPPLY 90052257PROBE BALL TIP 9450051 572272 STERILE SUPPLY 90052258NE MED PEDI/AC PROBE 945 1340272 STERILE SUPPLY 90052259DILATOR MEDTRONIC DISP 964270 MED-SUR SUPPLIES 90052260SCR GS MED SET/LOCK ALL 250278 OTHER IMPLANTS 90052261QUARDANT ILLUM SYST 956 2852270 MED-SUR SUPPLIES 90052262KNIFE BAYONETED 156300 1688272 STERILE SUPPLY 90052263IM SYN PRODISC C (CERV) 28758278 OTHER IMPLANTS 90052264SCR GS MED MIS ALL SIZES 6125278 OTHER IMPLANTS 90052265SCR PYRAMID + ANTERIOR B 500278 OTHER IMPLANTS 90052266PL PYRAMID 3HOLE LORD AL 11750278 OTHER IMPLANTS 90052267PL PYRAMID 4HOLE LORD AL 11250278 OTHER IMPLANTS 90052268BO LANX ALLOFUSE 5CC PUT 2875278 OTHER IMPLANTS 90052269BO LANX ALLOFUSE 1CC DBM 1050278 OTHER IMPLANTS 90052270DATASCOPE MONITOR MISC 950270 MED-SUR SUPPLIES 90052271IM DEP/SYN PULSE 1 LEVEL 14000278 OTHER IMPLANTS 90052272BO MTF/SYN CONFORM CERV 3000278 OTHER IMPLANTS 90052273IM DEP/SYN PULSE 2 LEVEL 21000278 OTHER IMPLANTS 90052274INST MEYERDING RETRACTOR 600270 MED-SUR SUPPLIES 90052275BO AES PROSPACE DBM PUTT 1875278 OTHER IMPLANTS 90052276IM ALPH BRDGPT SPINOUS A 14550278 OTHER IMPLANTS 90052277RESP AQUA PAK 1070ML 040 7270 MED-SUR SUPPLIES 90052279GASTROCCULT TEST KIT 660 4270 MED-SUR SUPPLIES 90052280IM ORTHOFIX FORZA TLIF P 12500278 OTHER IMPLANTS 90052282PL DEPUY BUTTRESS 20M 4000278 OTHER IMPLANTS 90052283SCR DEPUY BUTTRESS 20M 2000278 OTHER IMPLANTS 90052284IM DEP/SYN VIPER F2 MIS 17500278 OTHER IMPLANTS 90052286IM DEP/SYN PULSE 3 LEVEL 28000278 OTHER IMPLANTS 90052287I-STAT CARTRIDGE EG6+ 6F 32272 STERILE SUPPLY 90052288MALIBU SCR OMNIA POLYAXIAL 4050278 OTHER IMPLANTS 90052289SCR SEA DAYTONA SET 6000 250278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052290IM SEA MAL/DAY 4L LUM CN 35000278 OTHER IMPLANTS 90052294ECHECK 4X4.5X3 LEVELS 1247270 MED-SUR SUPPLIES 90052295ECHECK 5X1.5MX1 LO 199-5 584270 MED-SUR SUPPLIES 90052296ECHECK 5X15MX3 N/HI 1995 1191270 MED-SUR SUPPLIES 90052298LABEL MEDICAL ALERT 3708 67270 MED-SUR SUPPLIES 90052299MED NEURO PISCES QUAD 34 8950278 OTHER IMPLANTS 90052300MED NEURO EXT 1X8 3708 3405278 OTHER IMPLANTS 90052301MED NEURO PRIME 565 72500278 OTHER IMPLANTS 90052303PL ATLANTIS 40MM 876 3032278 OTHER IMPLANTS 90052304DRILL BIT VERTEX MAX 695 1416272 STERILE SUPPLY 90052305PL TSRH X10 CROSLINK 811 2000278 OTHER IMPLANTS 90052306BO MTF FRA SPACER 13M 00 14250278 OTHER IMPLANTS 90052307BO MTF FRA SPACER 15M 01 14250278 OTHER IMPLANTS 90052308SCR NUV PRECEPT SET/ LOC 250278 OTHER IMPLANTS 90052309GUIDEWIRE NUV PRECEPT AL 210272 STERILE SUPPLY 90052310SCR NUV PRECEPT MIS ALL 4500278 OTHER IMPLANTS 90052311ROD NUV PRECEPT PRBNT/ST 1470278 OTHER IMPLANTS 90052312BO NUMED 30C CAN/CHIP 10 2625278 OTHER IMPLANTS 90052313IM NUTEC SPINE 4L CERVIC 10850278 OTHER IMPLANTS 90052314PL NUTECH CERVICAL 3L AL 5300278 OTHER IMPLANTS 90052315BO NUTECH SI FIX ALLOGRF 30600278 OTHER IMPLANTS 90052316IM NUTECH DOMINO PAR/AXI 9895278 OTHER IMPLANTS 90052317ANES MASK BREATH LG 9270 MED-SUR SUPPLIES 90052318BB ARM BANDS 4270 MED-SUR SUPPLIES 90052319DO NOT USE SUCTION LIN 3000CC 65651 6270 MED-SUR SUPPLIES 90052320SANITIZER HAND TOWELETTE 4270 MED-SUR SUPPLIES 90052321BO SGT 1CC PASTE/GRAFTN 833278 OTHER IMPLANTS 90052323BO SP/GFT ISP CANC SPACE 5000278 OTHER IMPLANTS 90052324K WIRE ZI/SPI PATHFINDER 236278 OTHER IMPLANTS 90052325DILATOR ZI RADIOLU ALL S 448272 STERILE SUPPLY 90052326PL SEQUOIA CR/LINK ALL S 2000278 OTHER IMPLANTS 90052327SCR ZI/SPI PATHFINDER AL 6625278 OTHER IMPLANTS 90052328NE ZI/SP TARG/TROCAR 191 720272 STERILE SUPPLY 90052329NE ZI/SP TARG/BEVEL 191 720272 STERILE SUPPLY 90052330SCR ZI/SP SEQUOIA ALL S 2875278 OTHER IMPLANTS 90052333SURGICEL FIBRILLAR 2X4 1 3556272 STERILE SUPPLY 90052334SCR ZIM TRINICA CERV ALL 625278 OTHER IMPLANTS 90052335MILLING BIT SYN ALL SIZE 1814272 STERILE SUPPLY 90052336LABEL MEDICATION ADDED T 32270 MED-SUR SUPPLIES 90052337HAEMONETICS RESERVOIR 00205-00 300272 STERILE SUPPLY 90052354ROD FIREBIRD 2LVL ALL SZ 1125278 OTHER IMPLANTS 90052357CATHETER 22FR 30CC RIBBE 35270 MED-SUR SUPPLIES 90052358SU S/N FOOTPRINT KNOTLE 1978278 OTHER IMPLANTS 90052362GLOVE RADI RES 8.5 SSR1- 20270 MED-SUR SUPPLIES 90052365BO INT/SPI OSTEOSPARX 5C 2375278 OTHER IMPLANTS 90052368PL OSTEOMED PRIMALOK SPI 29750278 OTHER IMPLANTS 90052369IV SOL LR & 5% DEXTROSE 288270 MED-SUR SUPPLIES 90052371MASK LMA SIZE 2.5 PATIEN 100270 MED-SUR SUPPLIES 90052372MASK LMA SIZE 3 PATIENT 100270 MED-SUR SUPPLIES 90052373MASK LMA SIZE 4 PATIENT 100270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052374MASK LMA PROSEAL SZ 3 PA 100270 MED-SUR SUPPLIES 90052375MASK LMA PROSEAL SZ 4 PA 100270 MED-SUR SUPPLIES 90052376MASK LMA PROSEAL SZ 5 PA 100270 MED-SUR SUPPLIES 90052377MASK LMA SIZE 5 PATIENT 100270 MED-SUR SUPPLIES 90052390PIN AES DISTRACTION CASP 960278 OTHER IMPLANTS 90052392IM NUTECH SPINE 6L LUMBA 49000278 OTHER IMPLANTS 90052393BO INTE/ SP OSTEOSPARX 1 750278 OTHER IMPLANTS 90052394CATH MED ASCENDA PUMP LO 5500278 OTHER IMPLANTS 90052396IM AES ARCADIUS XP ALIF 25000278 OTHER IMPLANTS 90052397PIN AES CASPAR DISTRACTO 1760272 STERILE SUPPLY 90052399CLOUD 9 SHEET PATIENT CH 108270 MED-SUR SUPPLIES 90052400MASK LMA FAST TRACK 3 4 160270 MED-SUR SUPPLIES 90052401MASK LMA FLEXIBLE SZ 3 P 100270 MED-SUR SUPPLIES 90052402MASK LMA FLEXIBLE SZ 4 P 100270 MED-SUR SUPPLIES 90052403MASK LMA FLEXIBLE SZ 5 P 100270 MED-SUR SUPPLIES 90052404BO SP/GFT 5 CC PASTE T45 3375278 OTHER IMPLANTS 90052405SCR MED LEG/REDUCTION 4 4165278 OTHER IMPLANTS 90052407IM SP/ELE VERTU CERV PEE 12975278 OTHER IMPLANTS 90052408SCR SP/ELE VERTU CERV AL 1975278 OTHER IMPLANTS 90052409PLASTER SPLINT 3 X 15 4270 MED-SUR SUPPLIES 90052411LEAD KIT MED VECTRIS SU 12960278 OTHER IMPLANTS 90052412LEAD KIT VECTRIS SUBCOMP 12960278 OTHER IMPLANTS 90052413LEAD KIT VECTRIS SUBCOMP 12960278 OTHER IMPLANTS 90052414LEAD KIT VECTRIS COMPACT 12960278 OTHER IMPLANTS 90052415LEAD KIT VECTRIS COMPACT 12960278 OTHER IMPLANTS 90052416LEAD KIT VECTRIS COMPACT 12960278 OTHER IMPLANTS 90052423PL LDR ROI-C CERVICAL A 10000278 OTHER IMPLANTS 90052424IM LDR ROI-C PEEK CERVIC 10000278 OTHER IMPLANTS 90052425MEDTRONIC PATIENT PROGRA 3900278 OTHER IMPLANTS 90052426MEDTRONIC CHARGING SYST 9368278 OTHER IMPLANTS 90052427MEDTRONIC IPG BATTERY 9 95000278 OTHER IMPLANTS 90052428IM ULRICH CAG/VBR SM 14M 27100278 OTHER IMPLANTS 90052429IM MED WAVE D EXPANDABLE 19925278 OTHER IMPLANTS 90052430SCR ULRICH VBR SET TI CS 300278 OTHER IMPLANTS 90052431SCREW LEGACY HA ALL SIZE 5000278 OTHER IMPLANTS 90052432BO MTF ORTHOFIX TRINITY 2475278 OTHER IMPLANTS 90052433BO MTF ORTHOFIX TRINITY 11250278 OTHER IMPLANTS 90052434BO MTF ORTHOFIX TRINITY 19980278 OTHER IMPLANTS 90052435BO MTF ORTHOFIX TRINITY 26225278 OTHER IMPLANTS 90052436IM MED ITREL 4 37704 42500278 OTHER IMPLANTS 90052439BO SGT CORTICAL WEDGE PL 6250278 OTHER IMPLANTS 90052441STRYKER DRILL CORE MAETR 552270 MED-SUR SUPPLIES 90052452BO SPI/ELE LUCENT TIBOND 22500278 OTHER IMPLANTS 90052453PL ALPHATEC TRES/LUXE 3 5300278 OTHER IMPLANTS 90052454SCR SP/WAVE PS3 LUM ALL 2875278 OTHER IMPLANTS 90052455SCR SP/WAVE PS3 SET/ LOC 250278 OTHER IMPLANTS 90052456ROD SP/WAVE PS3 LUM 1 LE 750278 OTHER IMPLANTS 90052457CATH MED INTRATHECAL SPI 1200278 OTHER IMPLANTS 90052458KIT ARTHREX BIO-SUTURE D 640270 MED-SUR SUPPLIES 90052459TUBE NUV ET EMC ID ALL S 580270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052460TUBE NUV ET ADAPTER DUAL 108270 MED-SUR SUPPLIES 90052462SU S/N TWINFIX ULTRA ANC 1200278 OTHER IMPLANTS 90052465IM NUV PEEK CORORENT XL 23258278 OTHER IMPLANTS 90052469ROD INTEGRA DAYTONA PRE/ 1470278 OTHER IMPLANTS 90052470MALIBU SCR OMNIA LOCKING SET 450278 OTHER IMPLANTS 90052471SCR SEA MALIBU POLY/ RED 4500278 OTHER IMPLANTS 90052472ROD SEA MALIBU OFF SET C 2000278 OTHER IMPLANTS 90052473PIN NUTECH CERV TEMPORAR 370272 STERILE SUPPLY 90052474SCR SYN 25MM 218.025 258278 OTHER IMPLANTS 90052475SCR SYN 35MM 218.035 258278 OTHER IMPLANTS 90052476IM NUTECH LAMINAR HOOK S 4975278 OTHER IMPLANTS 90052477ROD NUTECH 5.5 X 300MM T 2500278 OTHER IMPLANTS 90052478ROD NUTECH 5.5 X 500MM T 3250278 OTHER IMPLANTS 90052479ROD NUTECH COBALT CHROME 4375278 OTHER IMPLANTS 90052481TAPE HY 1 10LF PINK 12270 MED-SUR SUPPLIES 90052482TAPE HY PINK 1/2 5LF 156270 MED-SUR SUPPLIES 90052487DORNOCH ENZYME CLEANER T 133270 MED-SUR SUPPLIES 90052488IM OMNIA AXLE CROSSBAR/PL CONST 32500278 OTHER IMPLANTS 90052489BO OMNIA TI INSERT 1500278 OTHER IMPLANTS 90052497SCR BIOMET W/LORENZ CRA 300278 OTHER IMPLANTS 90052498PL BIOMET W/LORENZE CRA 1063278 OTHER IMPLANTS 90052499ROD NUTECH TITANIUM PRE 1500278 OTHER IMPLANTS 90052500ROD NUTECH LATERAL/ OFF 3000278 OTHER IMPLANTS 90052501BO NUTECH DBM 10CC OCMP1 2000278 OTHER IMPLANTS 90052502BO NUTECH NUCEL SMALL NC 4500278 OTHER IMPLANTS 90052525BAG BLOOD TRANSFER 4R203 1826270 MED-SUR SUPPLIES 90052526IM NUTECH PLIF CAGE ALL 6250278 OTHER IMPLANTS 90052527SCR INNOVASIS EXCELLA MI 3000278 OTHER IMPLANTS 90052528ROD INNOVASIS EXCELLA PR 500278 OTHER IMPLANTS 90052529PL INNOVASIS EXCELLA CRO 2000278 OTHER IMPLANTS 90052530SCR INNOVASIS EXCELLA LO 250278 OTHER IMPLANTS 90052541SCR MED VOYAGER ALL SIZE 6625278 OTHER IMPLANTS 90052542ROD MED VOYAGER ALL SIZE 2155278 OTHER IMPLANTS 90052543SCR MED VOYAGER SET/ LOC 850278 OTHER IMPLANTS 90052544 ROD MED MRC AXIAL CONNECTOR 6.35 OPEN/ 6 3825 278 OTHER IMPLANTS 90052545SCR MED MRC SET/ LOCKING 450278 OTHER IMPLANTS 90052549PL TSRH X10 CROSSLINK 81 2000278 OTHER IMPLANTS 90052551SCR XSPINE FIXCET COMPRE 12500278 OTHER IMPLANTS 90052552DRILL XSPINE FIXCET FACE 288272 STERILE SUPPLY 90052553K-WIRE XSPINE FIXCET TRO 218278 OTHER IMPLANTS 90052554WASHER XSPINE FIXCET FAC 376278 OTHER IMPLANTS 90052555LEAD TRIAL VECTRIS COMPA 500278 OTHER IMPLANTS 90052560PL NUVASIVE AFFIX ALL SI 29430278 OTHER IMPLANTS 90052561PIN NUVASIVE AFFIX II CA 416278 OTHER IMPLANTS 90052563RECOVERY CHARGE TC 580710 RECOVERY ROOM 90052564PL BIOMET W/LORENZ CRANI 985278 OTHER IMPLANTS 90052566WASH BASIN 7 QRT H362-07 4270 MED-SUR SUPPLIES 90052567MED NEURO SURE SCAN PRIM 90000278 OTHER IMPLANTS 90052568SCR ORT FIREBIRD ALL SZS 2875278 OTHER IMPLANTS 90052569SCR ORT SET FIREBIRD 442 250278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052570SCR SEA SIERRA ALL SZS 5 3250278 OTHER IMPLANTS 90052571SCR SEA SIERRA LOC CAP 5 500278 OTHER IMPLANTS 90052572BO ZIMMER TANTALUM TM-40 14250278 OTHER IMPLANTS 90052573CABLE MEDTRONIC POWEREAS 1500270 MED-SUR SUPPLIES 90052574BO AES PROSPACE PEEK XP 7500278 OTHER IMPLANTS 90052575ROD FIREBIRD 3LVL ALL SZ 1500278 OTHER IMPLANTS 90052576GUIDE WIRE TSRH MED 803- 88272 STERILE SUPPLY 90052577SCR ZIM INVIZIA ALL SZS 625278 OTHER IMPLANTS 90052578MED NEURO ACCESSORY W/ E 800278 OTHER IMPLANTS 90052579MEDTRONIC BATTERY 97712 79690278 OTHER IMPLANTS 90052580MEDTRONIC RECHARGEABLE B 75440278 OTHER IMPLANTS 90052586MED NEURO ULTRA 565 SURG 92500278 OTHER IMPLANTS 90052592KIT ART BIO-TENODESIS AR 780278 OTHER IMPLANTS 90052593SCR ART TENODESIS AR-154 1725278 OTHER IMPLANTS 90052594SCR MED SOLERA DEGEN 4.7 2776278 OTHER IMPLANTS 90052595SCR MED SOLERA DEGEN SET 500278 OTHER IMPLANTS 90052596ROD MED SOLERA DEGEN PRE 1000278 OTHER IMPLANTS 90052597PL MED SOLERA DEGEN CROS 2000278 OTHER IMPLANTS 90052598MED KIT ACESSORY 3550-45 220270 MED-SUR SUPPLIES 90052599MED CATHETER PASSER 8591 392270 MED-SUR SUPPLIES 90052600LEAD KIT VECTRIS TRIAL 6810278 OTHER IMPLANTS 90052601ROD ORT FIREBIRD 4 LVL A 1875278 OTHER IMPLANTS 90052602IM ORT FIREBIRD CROSSLIN 2000278 OTHER IMPLANTS 90052603ROD ORT FIREBIRD 1 LEVEL 750278 OTHER IMPLANTS 90052605IM 4WEB TRUSS CERV ALL S 10160278 OTHER IMPLANTS 90052606IM CABLE AES SONGER DBL 2200278 OTHER IMPLANTS 90052610PL ALP TRES/LUX 4L 71004 5850278 OTHER IMPLANTS 90052611PL BIOMET W LORENZ 2 HOL 214278 OTHER IMPLANTS 90052612SCR MED SOLERA SAS ALL S 6000278 OTHER IMPLANTS 90052614STYLET GLIDESCOPE (PATIE 20270 MED-SUR SUPPLIES 90052615SOLIDIFIER BIO WASTE 120 7270 MED-SUR SUPPLIES 90052625SCR MED SET TI 6.35 7640 250278 OTHER IMPLANTS 90052627ROD ORT COBALT CHROME AL 2750278 OTHER IMPLANTS 90052628IM ORT ILLIAC OFFSET HEA 2000278 OTHER IMPLANTS 90052629NE ART SCORPION SUREFIRE 560270 MED-SUR SUPPLIES 90052632SCR NUV VUEPOINT POST CE 3250278 OTHER IMPLANTS 90052633SCR NUV VUEPOINT POST CE 500278 OTHER IMPLANTS 90052634ROD NUV VUEPOINT POST CE 900278 OTHER IMPLANTS 90052635KIT ARTHREX UCL DISPOSAB 2780270 MED-SUR SUPPLIES 90052636SU ART FIBERWIRE BB AR-7 172270 MED-SUR SUPPLIES 90052637SCR ART TENDONESIS BIOCO 1725278 OTHER IMPLANTS 90052639ROD MED VERTEX COBALT CH 7875278 OTHER IMPLANTS 90052641NE SPINAL 22X8IN QUINCKE 30278 OTHER IMPLANTS 90052642IM RENOVIS TESERA PEEK A 37500278 OTHER IMPLANTS 90052643PL RENOVIS TESERA COVER 3500278 OTHER IMPLANTS 90052644SCR RENOVIS TESERA ALIF 1000278 OTHER IMPLANTS 90052645ROD AES S4C POST CERV OF 4000278 OTHER IMPLANTS 90052647IM PYRAMESH CAGE OVOID X 32835278 OTHER IMPLANTS 90052648IM ALPH ARSENAL LUMBAR 1 12600278 OTHER IMPLANTS 90052649 VALENCIA IM OMNIA LUMBAR 2 LEVEL CONST 18900 278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052650IM ALPH ARSENAL LUMBAR 3 28000278 OTHER IMPLANTS 90052652SCR NUV PRECEPT MODULAR 2625278 OTHER IMPLANTS 90052654NE MED PAK BEVELED TIP 8 772270 MED-SUR SUPPLIES 90052655MED NEURO ACCESSORY 3550 220278 OTHER IMPLANTS 90052656IM BIOMET TSA 113629 32875278 OTHER IMPLANTS 90052657MIX BIOMET OPTIVAC 41900 264272 STERILE SUPPLY 90052658IM ALPHA TRES/LUXE 5L CE 12400278 OTHER IMPLANTS 90052659ROD MED 5.5MM TITANIUM 8 1149278 OTHER IMPLANTS 90052666PL MED PYRAMID DONIM 5535278 OTHER IMPLANTS 90052667SCR MED PYRAMID DONIM 473278 OTHER IMPLANTS 90052668PL MED SPIRE DONPL 7275278 OTHER IMPLANTS 90052669SCR MED SPIRE SET DONSCR 225278 OTHER IMPLANTS 90052670SCR MED ANCHOR FACET DON 9000278 OTHER IMPLANTS 90052671BO SGT MACH CORT RING AL 7125278 OTHER IMPLANTS 90052672BO SGT ORTHOBLEND 10CC D 3900278 OTHER IMPLANTS 90052673BO SGT AN/ RAMP DONBO 7125278 OTHER IMPLANTS 90052674BO ALP ALPHAGRAFT DBM/GE 3500278 OTHER IMPLANTS 90052675BO ALP ALPHAGRAFT DBM/GE 950278 OTHER IMPLANTS 90052676BAG ICE RECTANGE 5X12INW 4270 MED-SUR SUPPLIES 90052677CLIPS NV DSC IN-LINE ACT 1138270 MED-SUR SUPPLIES 90052678KIT ARTHREX SUTURE AR- 640270 MED-SUR SUPPLIES 90052679IM BOS/ SCI LINEAR ST LE 2800278 OTHER IMPLANTS 90052680CABLE BOS/ SCI TRIAL LEA 400270 MED-SUR SUPPLIES 90052681KIT BOS/ SCI TRIAL SC-65 375278 OTHER IMPLANTS 90052682SCR ZI/ SPI VIRAGE POST 3250278 OTHER IMPLANTS 90052683ROD ZI/SPI VIRAGE POST C 900278 OTHER IMPLANTS 90052684SCR ZI/SPI VIRAGE SET PO 500278 OTHER IMPLANTS 90052685MED NEURO TRIAL LEAD SIN 3000278 OTHER IMPLANTS 90052686MED NEURO TRIAL LEAD DOU 5500278 OTHER IMPLANTS 90052687SCR ALPH ARSENAL LUM ALL 2763278 OTHER IMPLANTS 90052688SCR ALPH ARSENAL SET/ LO 500278 OTHER IMPLANTS 90052689ROD ALPH ARSENAL 500MM A 1950278 OTHER IMPLANTS 90052690SCR ALPH ARSENAL OFF SET 2000278 OTHER IMPLANTS 90052692INST TAPE LIME GREEN 152 80270 MED-SUR SUPPLIES 90052693BO SPINALGRAFT AN/ RAMP 14250278 OTHER IMPLANTS 90052694IM DEPUY-SYNTHES MATRIX 14000278 OTHER IMPLANTS 90052695IM DEPUY SYNTHES OPAL RE 12500278 OTHER IMPLANTS 90052696SCR SYN BUTTRESS ALL SIZ 258278 OTHER IMPLANTS 90052697IM DEPUY- SYNTHES MATRIX 21000278 OTHER IMPLANTS 90052698ROD DEPUY- SYN MATRIX LU 700278 OTHER IMPLANTS 90052699MED GUIDEWIRE .062 SS 95 336272 STERILE SUPPLY 90052700PL MED ILIAC OFF SET CON 1800278 OTHER IMPLANTS 90052703BO SP/GFT LORDOTIC UNILA 12500278 OTHER IMPLANTS 90052705IM MED PRESTIGE LP CERV 22250278 OTHER IMPLANTS 90052706DRILL MED PRESTIGE 69721 500270 MED-SUR SUPPLIES 90052708IM ZI/SPI VEYRON CERV CA 14000278 OTHER IMPLANTS 90052709SCR ZI/SPI VEYRON CERV S 500278 OTHER IMPLANTS 90052710KIT BOS/ SCI SPECTRA IPG 85000278 OTHER IMPLANTS 90052711IM BOS/ SCI ARTISAN SURG 20000278 OTHER IMPLANTS 90052712IM BOS/ SCI 8 CONTACT PE 10000278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052716MED NEURO ULTRA DUAL 87875278 OTHER IMPLANTS 90052723IM JJ/SYN VECTRA 1 LEVEL 6200278 OTHER IMPLANTS 90052724CHARGING SYS KIT BOS/SCI 4000278 OTHER IMPLANTS 90052725PASSING ELEVATOR BOS/SCI 300278 OTHER IMPLANTS 90052726TUNNELING TOOL LONG BOS/ 800270 MED-SUR SUPPLIES 90052753KIT STRYKER KYPHO IVAS 0 5500278 OTHER IMPLANTS 90052754IM STRYKER KYPHO AUTOPLE 4000278 OTHER IMPLANTS 90052755KIT STRYKER KYPHO CANNUL 194278 OTHER IMPLANTS 90052756DRILL STRYKER KYPHO 11G 233270 MED-SUR SUPPLIES 90052757KIT STRYKER KYPHO 11G IV 213270 MED-SUR SUPPLIES 90052758NE ARROW EZ-IO 15MM 901 546270 MED-SUR SUPPLIES 90052759NE ARROW EZ-IO 25MM 9001 546270 MED-SUR SUPPLIES 90052760KIT EZ-IO STABILIZER 906 72270 MED-SUR SUPPLIES 90052761PL ALPH ARSENAL CROSS LI 2000278 OTHER IMPLANTS 90052762ROD AES S4 CERV DUAL DIA 1800278 OTHER IMPLANTS 90052764BO NUT/NUCEL LG MATRIX O 1750278 OTHER IMPLANTS 90052766PL SYN ATB 2LV 04.103 22500278 OTHER IMPLANTS 90052767SCR SYN ATB LOCKING 28MM 2270278 OTHER IMPLANTS 90052771IM MTF VERSASHIELD AMNIO 4691278 OTHER IMPLANTS 90052772IM MTF VERSASHIELD AMNIO 6499278 OTHER IMPLANTS 90052773IM MTF VERSASHIELD AMNIO 8745278 OTHER IMPLANTS 90052774IM MED TRANSVERSE PROCES 3750278 OTHER IMPLANTS 90052775BOLT SEA DAYTONA ILLIAC 6125278 OTHER IMPLANTS 90052777ROD LEG 35MM 8690035 450278 OTHER IMPLANTS 90052778NE TARGETING/JAMSHIDI 11 320270 MED-SUR SUPPLIES 90052779SCR DEP. MOUNTAINEER 3250278 OTHER IMPLANTS 90052780ROD DEP MOUNTAINEER 900278 OTHER IMPLANTS 90052781SCR DEP SET MOUNTAINEER 500278 OTHER IMPLANTS 90052782ROD MED LEG 100MM 869010 1161278 OTHER IMPLANTS 90052783IM TIDES MED AMNIOHEAL P 6250278 OTHER IMPLANTS 90052784IM TIDES MED AMNIOHEAL P 4550278 OTHER IMPLANTS 90052785PL SP/ ELE SAPPHIRE 4 LE 5850278 OTHER IMPLANTS 90052786IM MED TRANSVERS PROCESS 3750278 OTHER IMPLANTS 90052787ROD MED SOLERA TITANIUM/ 1000278 OTHER IMPLANTS 90052788BO NUV OSTEOCEL PRO MATR 12700278 OTHER IMPLANTS 90052789SCR PIONEER STREAMLINE P 3250278 OTHER IMPLANTS 90052790SCR PIONEER SET STREAMLI 500278 OTHER IMPLANTS 90052791ROD PIONEER STREAMLINE P 900278 OTHER IMPLANTS 90052793SCR AES ZODIAC SET/ LOCK 250278 OTHER IMPLANTS 90052794BO SGT ICW 10X20MM 17102 6250278 OTHER IMPLANTS 90052795BO PIO BIOSET IC DBM 5CC 3500278 OTHER IMPLANTS 90052796BO PIO BIOSET IC DBM 10C 5290278 OTHER IMPLANTS 90052799NE ASPIRATE NEWPORT INT 400270 MED-SUR SUPPLIES 90052800IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90052801KIT MED KYPHON EXPRESS I 3760270 MED-SUR SUPPLIES 90052802KIT MED KYPHON A08E 480270 MED-SUR SUPPLIES 90052803KIT MED KYPHON SIZE 2 F 320270 MED-SUR SUPPLIES 90052804KIT MED KYPHON DIAMOND/ 2800270 MED-SUR SUPPLIES 90052812IM TITAN TCS CERV PEEK A 12975278 OTHER IMPLANTS 90052813SCR TITAN TCS CERV LOCKI 1975278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052814KIT MED KYPHON EXPRESS I 3760278 OTHER IMPLANTS 90052815BO AES CESPACE XP ALL SZ 9000278 OTHER IMPLANTS 90052817SCR MED LEG 5.0 X 35MM 7 2776278 OTHER IMPLANTS 90052820IM MED RIALTO CANN CAGE 22000278 OTHER IMPLANTS 90052821PIN MED RIALTO GUIDE 901 220278 OTHER IMPLANTS 90052823PL ATL/VISION 19MM 97611 3032278 OTHER IMPLANTS 90052827NE NUV NVM5 IOM SSEP/ EM 5312270 MED-SUR SUPPLIES 90052828KIT AES HYDROLIFT APPLIC 1000270 MED-SUR SUPPLIES 90052829IM AES HYDROLIFT SIZE ME 49485278 OTHER IMPLANTS 90052830IM X-SPINE IRIX-A ALIF P 36900278 OTHER IMPLANTS 90052833IM X-SPINE IRIX-C CERV P 12975278 OTHER IMPLANTS 90052834SCR X-SPINE IRIX-C CERV 1975278 OTHER IMPLANTS 90052836ROD ALPH ARSENAL LUMBAR 975278 OTHER IMPLANTS 90052840IM MED PYRAMESH CAGE LON 43665278 OTHER IMPLANTS 90052841ROD MED SOLERA TI PRE BE 774278 OTHER IMPLANTS 90052844PL MED ZEVO CERV 37MM 3 3032278 OTHER IMPLANTS 90052845ZEVO SCR CERVICAL ALL SIZES 700278 OTHER IMPLANTS 90052846SU ART FIBERWIRE W/ NEED 74270 MED-SUR SUPPLIES 90052847SU ART SD WIRE LOOP AR-4 160270 MED-SUR SUPPLIES 90052848PL AURORA ZIP 51 MIS ISP 29750278 OTHER IMPLANTS 90052849BO ETEX EQUIVABONE GRAFT 14250278 OTHER IMPLANTS 90052850ROD NUV ASF15T LATERAL O 2500278 OTHER IMPLANTS 90052851IM NUV CONNECT/ ROTATE T 5250278 OTHER IMPLANTS 90052852SCR NUV LOCKING ILIAC AR 1575278 OTHER IMPLANTS 90052853SCR LEGACY 8.5 X 35MM 75 2776278 OTHER IMPLANTS 90052854ROD LEG 65 MM TITANIUM 8 1161278 OTHER IMPLANTS 90052855PIN AES DISTRACTION 12MM 176278 OTHER IMPLANTS 90052857ROD MED SOLERA PREBENT T 1161278 OTHER IMPLANTS 90052858SCR AES APFELBAUM ODONTO 2500278 OTHER IMPLANTS 90052859DRILL AES APFELBAUM ODON 800270 MED-SUR SUPPLIES 90052860GUIDEWIRE AES APFELBAUM 210272 STERILE SUPPLY 90052861IM AURORA DISCOVERY TINA 7500278 OTHER IMPLANTS 90052863LEAD MED HINGED 2X4 PADD 17500278 OTHER IMPLANTS 90052864MED NEURO EXTENSION 3708 7790278 OTHER IMPLANTS 90052865PL MED ZEVO CERV 51MM 30 3032278 OTHER IMPLANTS 90052866IM ZI/ SPI VEYRON ALIF P 37500278 OTHER IMPLANTS 90052867SCR ZI/ SPI VEYRON ALIF 1500278 OTHER IMPLANTS 90052868PL AES SPECTRUM 3 LEVEL 5300278 OTHER IMPLANTS 90052869SCR SYN ATB 30MM 0420103 2395278 OTHER IMPLANTS 90052870IM ULRICH OBELISC VBR CE 35000278 OTHER IMPLANTS 90052871PL ULRICH OBELISC VBR EN 11000278 OTHER IMPLANTS 90052872SCR ULRICH LOCKING OBELISC VBR 675278 OTHER IMPLANTS 90052873PL ALP TRES/LUX 5 LV 710 6400278 OTHER IMPLANTS 90052874PL MED ZEVO CERV 73MM 30 2780278 OTHER IMPLANTS 90052875IM PARADIGM COFLEX INTER 27000278 OTHER IMPLANTS 90052876PL MED ZEVO CERV 19MM 30 2780278 OTHER IMPLANTS 90052878PL MED ZEVO CERV 39MM 3002039 3032278 OTHER IMPLANTS 90052881IM STRYKER XIA LUMBAR 1 14000278 OTHER IMPLANTS 90052882IM STRYKER TLIF PEEK ALL 11250278 OTHER IMPLANTS 90052884PL MED ZEVO CERV 57MM 30 3032278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052885ROD MED SOLERA TITANIUM 1161278 OTHER IMPLANTS 90052886PL MED ZEVO CERV 23MM 30 2780278 OTHER IMPLANTS 90052887BO AES PROSPACE DBM PAST 950278 OTHER IMPLANTS 90052888PL MED ZEVO CERV 21MM 30 2780278 OTHER IMPLANTS 90052889PL MED ZEVO CERV 55MM 30 3032278 OTHER IMPLANTS 90052890LAB AGGLUTINATION VIEWER 211270 MED-SUR SUPPLIES 90052892MED NEURO EXTENSION 3708 3405278 OTHER IMPLANTS 90052893PL MED ZEVO CERV 63MM 30 2780278 OTHER IMPLANTS 90052894SPLINT REBOUND PLANTAR 240270 MED-SUR SUPPLIES 90052895PL MED VISI/ ATL ELITE C 3032278 OTHER IMPLANTS 90052896SCR MED VISION ELITE CER 792278 OTHER IMPLANTS 90052897SU ARTHREX LASSO 45 DEG 560270 MED-SUR SUPPLIES 90052898XENOSURE BIOLOGIC PATCH 396278 OTHER IMPLANTS 90052899BO RTI BIOREADY DBM PUTT 400278 OTHER IMPLANTS 90052900BO RTI BIOREADY DBM PUTT 950278 OTHER IMPLANTS 90052901NE MEDTRONIC KYPHON BIOP 368270 MED-SUR SUPPLIES 90052902ROD MED SOLERA PREBENT 5 1000278 OTHER IMPLANTS 90052903ROD NUV RELINE MAS TITAN 1470278 OTHER IMPLANTS 90052904SCR NUV RELINE MAS LUM P 6125278 OTHER IMPLANTS 90052905SCR NUV RELINE MAS SET/ 250278 OTHER IMPLANTS 90052906PLASTIC CHARGE PLATE HOL 5270 MED-SUR SUPPLIES 90052911MED NEURO BATTERY REPLAC 62500278 OTHER IMPLANTS 90052912PL MED ZEVO CERV 41MM 30 2780278 OTHER IMPLANTS 90052913ROD LEG PRE BENT 4.5MM 8 1161278 OTHER IMPLANTS 90052915PL MED ZEVO CERV 21MM 30 3032278 OTHER IMPLANTS 90052916ROD MED SOLERA PRE BENT 1161278 OTHER IMPLANTS 90052917MASK LMA SZ #2 CLMA20R 520270 MED-SUR SUPPLIES 90052919BROSELOW RED IV DELIVERY MODULE 288270 MED-SUR SUPPLIES 90052920BROSELOW PURPLE IV DELIVERY MOD 300270 MED-SUR SUPPLIES 90052921BROSELOW YELLOW IV DELIVERY MODULE 300270 MED-SUR SUPPLIES 90052922BROSELOW WHITE IV DELIVERY MODULE 288270 MED-SUR SUPPLIES 90052923BROSELOW BLUE IV DELIVERY MODULE 300270 MED-SUR SUPPLIES 90052924BROSELOW ORANGE IV DELIVERY MODULE 300270 MED-SUR SUPPLIES 90052925BROSELOW GREEN IV DELIVERY MODULE 300270 MED-SUR SUPPLIES 90052926PL MED ZEVO CERV 43MM 30 3032278 OTHER IMPLANTS 90052927PL MED ZEVO CERV 45MM 30 2780278 OTHER IMPLANTS 90052928KIT STRYKER CURETTE 11G 2272270 MED-SUR SUPPLIES 90052931PL ALP TRES/LUX CERV 1 L 4200278 OTHER IMPLANTS 90052934SCR DEPUY- SYN MATRIX LU 2700278 OTHER IMPLANTS 90052935SCR DEPUY- SYN MATRIX SE 450278 OTHER IMPLANTS 90052937PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90052938PIN TEMP RTI 25-PUSHPI 296270 MED-SUR SUPPLIES 90052940IM SCENDIA COSMO 1L LUMB 14000278 OTHER IMPLANTS 90052941SCR SCENDIA COSMOLOCK PE 2875278 OTHER IMPLANTS 90052942IM OMNIA CALIX-T PC TLIF 22500278 OTHER IMPLANTS 90052943ROD SCENDIA COSMOS PRE-B 750278 OTHER IMPLANTS 90052944IM SCENDIA INTESS PEEK C 12500278 OTHER IMPLANTS 90052945ROD SCENDIA COSMO LUM AL 750278 OTHER IMPLANTS 90052947PL MED ZEVO CERV 35MM 30 2728.8278 OTHER IMPLANTS 90052952BO ALP SELF DISTRACTING 6250278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90052953PL MED ZEVO CERV 53MM 30 3032278 OTHER IMPLANTS 90052954BO RTI BIOREADY DBM PUTT 775278 OTHER IMPLANTS 90052955ROD MED MRC SIDE LOADING 4250278 OTHER IMPLANTS 90052956PL MED ZEVO CERV 29MM 30 3032278 OTHER IMPLANTS 90052957SCR SYN ATB 24MM 0420102 2395278 OTHER IMPLANTS 90052958BO NOVABONE PUTTY 5CC NB 5235278 OTHER IMPLANTS 90052959BO NOVABONE 10CC NB0610 8500278 OTHER IMPLANTS 90052960BO NOVABONE MACROFORM BI 5235278 OTHER IMPLANTS 90052961BO NOVABONE MACROFORM BI 8500278 OTHER IMPLANTS 90052962PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90052963PL MED ZEVO CERV 48MM 30 3032278 OTHER IMPLANTS 90052964IM ORTHOFIX CONSTRUX MIN 7500278 OTHER IMPLANTS 90052965PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90052967MED NEURO ADVANCED DUAL 80000278 OTHER IMPLANTS 90052969PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90052970BO SPINALGRAFT AN/RAMP 1 14250278 OTHER IMPLANTS 90052971MESH MED TYREX NEURO ABS 3980278 OTHER IMPLANTS 90052972PL MED ZEVO CERV 59MM 30 3032278 OTHER IMPLANTS 90052973MODULE NUV NV RM NVM5 IO 4396270 MED-SUR SUPPLIES 90052974IM SCENDIA COSMO 2 L LUM 21000278 OTHER IMPLANTS 90052975IM CENT MIDLINE II-TI CA 41000278 OTHER IMPLANTS 90052976MAGNUM IM SP/ ELEMENTS TI BOND ALIF 36000278 OTHER IMPLANTS 90052977MAGNUM SCR SP/ ELEMENTS 1125278 OTHER IMPLANTS 90052979PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90052981KIT KING LTS SIZE 4 RED 144270 MED-SUR SUPPLIES 90052982KIT KING LTS SIZE 5 PURP 144270 MED-SUR SUPPLIES 90052983KIT KING LTS SIZE 2 GREE 164270 MED-SUR SUPPLIES 90052984KIT KING LTS SIZE 3 YELL 144270 MED-SUR SUPPLIES 90052986SU ART ANCHOR CORKSCREW 980278 OTHER IMPLANTS 90052989IM ALPH ARSENAL LUMBAR 4 35000278 OTHER IMPLANTS 90052990LTA MADGIC ATOMIZER DEVI 933270 MED-SUR SUPPLIES 90052992BO AES TSPACE XP TLIF AL 11250278 OTHER IMPLANTS 90052993IM OMN MONZA 2LVL 6975278 OTHER IMPLANTS 90052995IM OMNIA COMPLETE CERVIC 13000278 OTHER IMPLANTS 90052996SCR OMNIA COMPLETE CERVI 1000278 OTHER IMPLANTS 90052997PL MED ZEVO CERV 78MM 30 2780278 OTHER IMPLANTS 90052999VU APOD IM OMNIA PRIME ALIF PEEK 38250278 OTHER IMPLANTS 90053000VU APOD PL OMNIA SPIN PLATE ALL SIZES 1250278 OTHER IMPLANTS 90053001IM OMN MONZA 1LVL 5580278 OTHER IMPLANTS 90053003IM AES MODULIFT EXPAND C 27500278 OTHER IMPLANTS 90053004PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90053006PL OMNIA MONZA 4 LEVEL A 5850278 OTHER IMPLANTS 90053007IM OMN 4LVL MONZA CER 9765278 OTHER IMPLANTS 90053008BIOMET COMP SHOULDER SYS 24030278 OTHER IMPLANTS 90053009DRILL BIOMET 1/8 INCH QU 412270 MED-SUR SUPPLIES 90053010BIOMET COMP SHOULDER SYS 1070278 OTHER IMPLANTS 90053011BIOMET POROUS TITANIUM G 2620278 OTHER IMPLANTS 90053012BIOMET HYB GLENOID BASE 8985278 OTHER IMPLANTS 90053013BIOMET VERSA DIAL SHOULD 10125278 OTHER IMPLANTS 90053014BIOMET HYB GLENOID REGEN 2620278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053015ROD NUTECH LUMBAR 3 LEVE 1250278 OTHER IMPLANTS 90053016ROD OMNIA VALENCIA MI AL 750278 OTHER IMPLANTS 90053017SCR OMNIA VALENCIA T25 M 4050278 OTHER IMPLANTS 90053018SCR OMNIA VALENCIA LOCKI 250278 OTHER IMPLANTS 90053019BOWL ZIMMER QUICK-VAC MI 680270 MED-SUR SUPPLIES 90053020BO ZIMMER PALACOS LV+G 1 1591278 OTHER IMPLANTS 90053021SCR MED SOLERA 4.75 SYST 3750278 OTHER IMPLANTS 90053023ROD MED SOLERA 4.75 SYST 1000278 OTHER IMPLANTS 90053024CORD MINDRAY DATASCOPE D 103270 MED-SUR SUPPLIES 90053025PL MED ATL/ VIS ELITE CE 3032278 OTHER IMPLANTS 90053026BO RTI BIOREADY DBM PUTT 455278 OTHER IMPLANTS 90053027IM OMN MONZA 3LV 9300278 OTHER IMPLANTS 90053028PL OMNIA MONZA CERV 2 LE 4750278 OTHER IMPLANTS 90053029SCR OMNIA MONZA CERVICAL 500278 OTHER IMPLANTS 90053030IM OMNIA VALENCIA MI CRO 2000278 OTHER IMPLANTS 90053031IM ALPH ARSENAL LUMBAR 6 49000278 OTHER IMPLANTS 90053032SCR UCSS 32MM 873-132 3170278 OTHER IMPLANTS 90053033GUIDEWIRE UCSS TREADED 8 412272 STERILE SUPPLY 90053035PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90053036ROD MED 5.5 TITANIUM LIN 1064278 OTHER IMPLANTS 90053037PL ZI/ SPI OCCIPITAL SMA 24500278 OTHER IMPLANTS 90053038ROD ZI/ SPI OCCIPITAL PR 3975278 OTHER IMPLANTS 90053039SCR ZI/ SPI OCCIPITAL AL 2975278 OTHER IMPLANTS 90053043ENVELOPE 9 X 12 DISCHAR 1080270 MED-SUR SUPPLIES 90053044ENVELOPE 6 X 9 DISCHARGE 816270 MED-SUR SUPPLIES 90053045MED NEURO SENSOR SURGICA 100000278 OTHER IMPLANTS 90053046MED NEURO PRIME SURG 977 90000278 OTHER IMPLANTS 90053047MED NEURO SENSOR PERC 97 95000278 OTHER IMPLANTS 90053048IM MED DIVERGANCE ALIF P 14250278 OTHER IMPLANTS 90053049PL MED DIVERGANCE COVER 14250278 OTHER IMPLANTS 90053050SCR MED DIVERGANCE FIX/ 1000278 OTHER IMPLANTS 90053051MASIMO EAR SENSOR SPO2 0 500270 MED-SUR SUPPLIES 90053052BROSELOW RED KIT INTUBATION 300270 MED-SUR SUPPLIES 90053053BROSELOW PURPLE KIT INTUBATION 300270 MED-SUR SUPPLIES 90053054BROSELOW YELLOW KIT INTUBATION 300270 MED-SUR SUPPLIES 90053055BROSELOW WHITE KIT INTUBATION 300270 MED-SUR SUPPLIES 90053056BROSELOW BLUE KIT INTUBATION 300270 MED-SUR SUPPLIES 90053057BROSELOW ORANGE KIT INTUBATION 300270 MED-SUR SUPPLIES 90053058BROSELOW GREEN KIT INTUBATION 300270 MED-SUR SUPPLIES 90053059ROD MED OCCIPITAL PRE CU 900278 OTHER IMPLANTS 90053060PL MED OCCIPITAL KEEL AL 21500278 OTHER IMPLANTS 90053061PIPETTE STAND 6 POSITION 352270 MED-SUR SUPPLIES 90053062PL MED ZEVO CERV 17MM 30 3032278 OTHER IMPLANTS 90053063PL MONZA OMNIA 3 LEVEL O 5300278 OTHER IMPLANTS 90053064BO NUT/NUCEL MED NC-1001 4500278 OTHER IMPLANTS 90053067BO ZIM PUROS 10CC DBM W/ 6125278 OTHER IMPLANTS 90053069BO OMNIA PEEK CERV CALIX 2790278 OTHER IMPLANTS 90053070PIRANHA IM 3 LEVEL CERVICAL CONST. 8370278 OTHER IMPLANTS 90053071BO OMNIA DBM PUTTY 1CC O 950278 OTHER IMPLANTS 90053072BO OMNIA DBM PUTTY 10CC 5515278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053073IM OMNIA IRIX-A PEEK ALL 36900278 OTHER IMPLANTS 90053074SCR OMNIA IRIX-A ALL SZS 500278 OTHER IMPLANTS 90053075SCR NUV ARM15T LUM POLYA 3000278 OTHER IMPLANTS 90053076SCR NUV ARMADA LOCKING C 250278 OTHER IMPLANTS 90053077ROD NUV ARM15T 2 LEVEL A 1000278 OTHER IMPLANTS 90053078SCR NUV PRECEPT SHANK MO 2704278 OTHER IMPLANTS 90053079SCR NUV PRECEPT TULIP MO 3605278 OTHER IMPLANTS 90053080BO OMNIA 10CC VIA GRAFT 14250278 OTHER IMPLANTS 90053081BO COMM TRI-CORTICAL BLO 2600278 OTHER IMPLANTS 90053082BO COMM TRI-CORTICAL BLO 3600278 OTHER IMPLANTS 90053083PIRANHA IM 2 LEVEL CERVICAL CONST. 6975278 OTHER IMPLANTS 90053084BO OMNIA DBM PUTTY 5CC O 2755278 OTHER IMPLANTS 90053086ROD MED SOLERA PREBENT T 774278 OTHER IMPLANTS 90053089ROD MED SOLERA PRE BENT 774278 OTHER IMPLANTS 90053090PL MED ZEVO CERV 61MM 30 2780278 OTHER IMPLANTS 90053092SENSOR GENMED SIGHT SAVE 4700278 OTHER IMPLANTS 90053093BO SPINALGRAFT AN/RAMP 1 14250278 OTHER IMPLANTS 90053094BO SPINALGRAFT AN/RAMP 2 14250278 OTHER IMPLANTS 90053095SCR OMNIA VU-APOD PRIME 1250278 OTHER IMPLANTS 90053096MED KIT SURGICAL LIGHT 2 2336270 MED-SUR SUPPLIES 90053097ROD SEA MALIBU PRECONT A 1470278 OTHER IMPLANTS 90053098SCR ACUMED ACUTRAK 2 MIC 2640278 OTHER IMPLANTS 90053099DRILL ACUMED ACUTRAK 2 M 1144270 MED-SUR SUPPLIES 90053100DRILL ACUMED ACUTRAK 2 M 1276270 MED-SUR SUPPLIES 90053101GUIDEWIRE ACUMED ACUTRAK 64272 STERILE SUPPLY 90053102PIRANHA IM 1 LEVEL CERVICAL CONST. 5580278 OTHER IMPLANTS 90053103PATIENT WALKER 32 - 39" 102270 MED-SUR SUPPLIES 90053104PATIENT WALKER 33-43" 50 283270 MED-SUR SUPPLIES 90053105SCR UCSS 34MM X873-134 2735278 OTHER IMPLANTS 90053106PL NUTECH CROSSLINK ALL 2000278 OTHER IMPLANTS 90053107IM MED PIVOX CLYDESDALE 23750278 OTHER IMPLANTS 90053108ROD MED SOLERA PREBENT 5 1161278 OTHER IMPLANTS 90053109PL MED ZEVO CERV 35MM 30 3032278 OTHER IMPLANTS 90053110IM OMNIA HOLLYWOOD TLIF 11250278 OTHER IMPLANTS 90053111PL MED ZEVO CERV 27MM 30 3032278 OTHER IMPLANTS 90053112IM OMNIA KYPHO OSTEOFLEX 725278 OTHER IMPLANTS 90053113KIT KYPHO INTVM-15-DDK 8320278 OTHER IMPLANTS 90053114BO ZIMMER BIOMET INTERGR 6125278 OTHER IMPLANTS 90053115BO ZIMMER BIOMET INTERGR 3500278 OTHER IMPLANTS 90053116IM MED HOOK SMALL PEDICL 3500278 OTHER IMPLANTS 90053117IM MED TRANSVERSE SMALL 3750278 OTHER IMPLANTS 90053118ROD SPI/ELE MERCURY COBA 2940278 OTHER IMPLANTS 90053119ROD MED SOLERA PRE BENT 774278 OTHER IMPLANTS 90053120BO NUVASIVE PROPEL DBM 1 6125278 OTHER IMPLANTS 90053121PL MED ZEVO CERV 32MM 30 3032278 OTHER IMPLANTS 90053122PL MED ZEVO CERV 45MM 30 3032278 OTHER IMPLANTS 90053124BO ZIMMER PUROS DBM GEL 950278 OTHER IMPLANTS 90053125PL MED ZEVO CERV 48MM 30 3032278 OTHER IMPLANTS 90053126CATHETER INTUBATION AINT 343270 MED-SUR SUPPLIES 90053127SCR SP/ELE MERCURY CANNU 4050278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053128ROD SCENDIA COSMOLOCK 25 1875278 OTHER IMPLANTS 90053129SCR SCENDIA LOCKING CAP 250278 OTHER IMPLANTS 90053130PL MED ZEVO CERV 33MM 30 3032278 OTHER IMPLANTS 90053131IM MED BLADE HOOK WIDE L 4000278 OTHER IMPLANTS 90053132PL MED ZEVO CERV 25MM 30 2780278 OTHER IMPLANTS 90053137ROD SCENDIA COSMOLOCK 2L 1125278 OTHER IMPLANTS 90053139IM MED HOOK LARGE NARROW 3750278 OTHER IMPLANTS 90053141IM CTL CERVICAL 1 LEVEL 6200278 OTHER IMPLANTS 90053142MED NEURO RESTORE INSERT 102500278 OTHER IMPLANTS 90053143IM CTL CERVICAL 2 LEVEL 7750278 OTHER IMPLANTS 90053144PIN MED ZEVO PLATE HOLDI 496270 MED-SUR SUPPLIES 90053148MED KYPHON SYRINGE A08A 300270 MED-SUR SUPPLIES 90053149PL RTI OFFSET CONNECTOR 2000278 OTHER IMPLANTS 90053150BO SMART MORSELIZED ALLO 9675278 OTHER IMPLANTS 90053151IM SMART CANCELLOUS CRUS 3500278 OTHER IMPLANTS 90053152SCR SCENDIA COSMO LOCKIN 250278 OTHER IMPLANTS 90053153IM KYPHON BONE CEMENT HV 715278 OTHER IMPLANTS 90053154WASHCLOTHS BATH CLEASING 8270 MED-SUR SUPPLIES 90053155ROD MED SOLERA TIT 50MM 774278 OTHER IMPLANTS 90053156IM SCENDIA COSMO 3L LUMB 28000278 OTHER IMPLANTS 90053157MED NEURO RESTORE ADVANC 77500278 OTHER IMPLANTS 90053160CAMBRIA IM SEASPINE CERV SPACER 9000278 OTHER IMPLANTS 90053161IM BIOMET MAYAN GREEN 2 7750278 OTHER IMPLANTS 90053162BO OMNIA 1CC VIA GRAFT O 1425278 OTHER IMPLANTS 90053163GUIDE WIRE OMNIA 909-048 210272 STERILE SUPPLY 90053164BO OMNIA 5CC VIA GRAFT O 7125278 OTHER IMPLANTS 90053165IM MED LEAD SURESCAN SP 30380278 OTHER IMPLANTS 90053174SCR OMNIA ILIAC BOLT ALL 4275278 OTHER IMPLANTS 90053175PL OMNIA ILIAC CROSS CON 2000278 OTHER IMPLANTS 90053176SCR OMNIA ILIAC SET ALL 500278 OTHER IMPLANTS 90053177ROD OMNIA VALENCIA MI 40 2940278 OTHER IMPLANTS 90053178KIT BOS/ SCI COVEREDGE S 115000278 OTHER IMPLANTS 90053179ROD MED MRC 6.35 OPEN 6. 3825278 OTHER IMPLANTS 90053180IM CTL CERVICAL 3 LEVEL 9300278 OTHER IMPLANTS 90053181WIRE BOS/ SCI OR CABLE 1 4270 MED-SUR SUPPLIES 90053182SUCTION CANNISTERS CRASH 17270 MED-SUR SUPPLIES 90053183ROD MED SOLERA CHROMALLO 1161278 OTHER IMPLANTS 90053184BO DCI PLIF SPACER PARAL 5625278 OTHER IMPLANTS 90053185ROD SCENDIA CURVED 3 LVL 1500278 OTHER IMPLANTS 90053189SCR OMNIA VALENCIA ILIAC 3850278 OTHER IMPLANTS 90053190ROD SPI/ELE MERCURY COBA 4195278 OTHER IMPLANTS 90053191ROD SPI/ELE MERCURY COBA 4195278 OTHER IMPLANTS 90053192PL MED ZEVO CERV 71MM 30 3032278 OTHER IMPLANTS 90053193ROD SPI/ELE MERCURY COBA 2940278 OTHER IMPLANTS 90053194BO CERA IFACTOR BONE GRA 8000278 OTHER IMPLANTS 90053195IM ZIM-BIO ARDIS TANTALU 17000278 OTHER IMPLANTS 90053196BO VIVEX VIA FORM MOLDAB 11400278 OTHER IMPLANTS 90053197TRAY BIOHAZARD SST SYSTE 969270 MED-SUR SUPPLIES 90053198BO ZIM PUROS PLIF HAHN A 6250278 OTHER IMPLANTS 90053199IM GENSANO XPLUS MEMBRAN 4095278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053201MEDTRONIC SURESCAN PADDL 30380278 OTHER IMPLANTS 90053202BO AMENDIA ORIOS MATRIX 14250278 OTHER IMPLANTS 90053203PL MED ZEVO CERV 83MM 30 3032278 OTHER IMPLANTS 90053204PL MED ZEVO CERV 86MM 30 3032278 OTHER IMPLANTS 90053205MED NEURO ASCENDA PUMP R 2500278 OTHER IMPLANTS 90053206IM SOPHYSA POLARIS ADJUS 16230278 OTHER IMPLANTS 90053207CATHETER SOPHYSA VENTRIC 592278 OTHER IMPLANTS 90053208BO GENSANO CERVICAL SPAC 3100278 OTHER IMPLANTS 90053209KIT BOS/ SCI PRECISION S 91000278 OTHER IMPLANTS 90053214IM OMNIA ENDURAMESH(CERV 18300278 OTHER IMPLANTS 90053215PIRANHA PL CERVICAL 2 LEVEL 4750278 OTHER IMPLANTS 90053216PIRANHA SCR CERVICAL ALL SIZES 500278 OTHER IMPLANTS 90053217IM AES MODULIFT SZ M END 4765278 OTHER IMPLANTS 90053218ROD MED SOLERA PREBENT 9 1161278 OTHER IMPLANTS 90053219PL MED ZEVO CERV 71MM 30 3032278 OTHER IMPLANTS 90053221AIM INTRAOPERATIVE MONITORIN 2000270 MED-SUR SUPPLIES 90053222PL NUV AFFIX II 45MM 757 21375278 OTHER IMPLANTS 90053223SCR OMNIA VALENCIA ILIAC 500278 OTHER IMPLANTS 90053224CATH MED ASCENDA PUMP 87 2200278 OTHER IMPLANTS 90053225IM ZIMMER TIMBERLINE LAT 41250278 OTHER IMPLANTS 90053227BO OMNIA REBAR CERVICAL 2790278 OTHER IMPLANTS 90053229BO OBEY DEMINERALIZED CA 8500278 OTHER IMPLANTS 90053230BO OBEY CELERA ALLOGRAFT 7125278 OTHER IMPLANTS 90053232IM WRIGHT EVOLVE RADIAL 13450278 OTHER IMPLANTS 90053233IM WRIGHT EVOLVE RADIAL 15985278 OTHER IMPLANTS 90053234PL ACUMED ELBOW OLECRANO 6880278 OTHER IMPLANTS 90053235SCR ACUMED NONLOCKING HE 450278 OTHER IMPLANTS 90053236SCR ACUMED LOCKING HEXAL 3.5 X 14 750278 OTHER IMPLANTS 90053237SCR ACUMED LOCKING HEXAL 750278 OTHER IMPLANTS 90053238SCR ACUMED LOCKING HEXAL 750278 OTHER IMPLANTS 90053239DRILL ACUMED QUICK RELEA 608270 MED-SUR SUPPLIES 90053240DRILL ACUMED QUICK RELEA 640270 MED-SUR SUPPLIES 90053242K-WIRE ACUMED 2.0MM X 9" 120270 MED-SUR SUPPLIES 90053243GUIDEWIRE MEDTRONIC 7570 220272 STERILE SUPPLY 90053244BO OBEY FORMA FLEXIBLE S 5235278 OTHER IMPLANTS 90053245CRYSTAL BO SPI/ ELE CERV TI-BOND 9000278 OTHER IMPLANTS 90053246BO OMNIA MORPHEUS BONE G 5385278 OTHER IMPLANTS 90053247IM S/N FOOTPRINT KNOTLES 1978278 OTHER IMPLANTS 90053253MED KIT ACCESSORY 3550-4 220270 MED-SUR SUPPLIES 90053254BO OBEY FORMA FLEXIBLE S 8500278 OTHER IMPLANTS 90053255PL KJM BUTTRESS W/ LOCKI 14000278 OTHER IMPLANTS 90053256SCR KJM BUTTRESS 5.5 X 2 1000278 OTHER IMPLANTS 90053258BO OBEY CELERA ALLOGRAFT 14250278 OTHER IMPLANTS 90053259ROD MALIBU COBALT CHROME 2940278 OTHER IMPLANTS 90053261IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90053262IM OMNIA SAVANNAH-T LUMB 35000278 OTHER IMPLANTS 90053265BROSELOW RED KIT INTRAOSSEUS 360270 MED-SUR SUPPLIES 90053266BROSELOW PURPLE KIT INTRAOSSEUS 360270 MED-SUR SUPPLIES 90053267BROSELOW YELLOW KIT INTRAOSSEUS 360270 MED-SUR SUPPLIES 90053268BROSELOW WHITE KIT INTRAOSSEUS 360270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053269BROSELOW BLUE KIT INTRAOSSEUS 360270 MED-SUR SUPPLIES 90053270BROSELOW ORANGE KIT INTRAOSSEUS 360270 MED-SUR SUPPLIES 90053273SAVANNAH SCR OMNIA SET LOCKING 250278 OTHER IMPLANTS 90053274PL OMNIA SAVANNAH X-LINK 1800278 OTHER IMPLANTS 90053275ROD OMNIA SAVANNAH CO CR 2940278 OTHER IMPLANTS 90053277PL MED ZEVO CERV 330102 3032278 OTHER IMPLANTS 90053278BO SGT IMPACTED CORTICAL 6250278 OTHER IMPLANTS 90053279IM ORTFIX PILLAR SAPTC A 37500278 OTHER IMPLANTS 90053280BRACE DJO BACK TLSO XL 2500270 MED-SUR SUPPLIES 90053284PIRANHA IM 4 LEVEL CERVICAL CONST. 10850278 OTHER IMPLANTS 90053285SAVANNAH ROD OMNIA CURVED 1470278 OTHER IMPLANTS 90053287KIT KYPHOPAK EXPRESS KPE 14750270 MED-SUR SUPPLIES 90053288PL AMENDIA BUTTRESS 23MM 4475278 OTHER IMPLANTS 90053289SCR AMENDIA BUTTRESS 25M 1875278 OTHER IMPLANTS 90053290BO AMENDIA VIA GRAFT-M S 14250278 OTHER IMPLANTS 90053291BO COMM 15C CANC CUBES 1 1300278 OTHER IMPLANTS 90053292SCR SEA MALIBU ILIAC BOL 4500278 OTHER IMPLANTS 90053293ROD OMN VAL/SAV COCR 600 2940278 OTHER IMPLANTS 90053294SCR OMNIA LATERAL CONNEC 500278 OTHER IMPLANTS 90053295BO AMENDIA 5CC DBM CEMO- 3063278 OTHER IMPLANTS 90053296SCR ASTURA OLYMPIC CANNU 4500278 OTHER IMPLANTS 90053297SCR ASTURA OLYMPIC SET A 250278 OTHER IMPLANTS 90053298ROD ASTURA OLYMPIC ROD L 1470278 OTHER IMPLANTS 90053299BO AMENDIA PROVENDA-FLO 6415278 OTHER IMPLANTS 90053300BO AMENDIA NEVOS SPONGE 7650278 OTHER IMPLANTS 90053301BO AMENDIA NEVOS DBM FIB 3063278 OTHER IMPLANTS 90053302BO AMENDIA NEVOS SPONGE 7650278 OTHER IMPLANTS 90053303IM INTEGRITY FLAREHAWK E 25000278 OTHER IMPLANTS 90053304BO AMENDIA PROVENDA-FLO 12825278 OTHER IMPLANTS 90053305NE 25G X 5 SPINAL BD BF4 24270 MED-SUR SUPPLIES 90053306PL SYN 3.5MM LCP 9HOLE 1 2800278 OTHER IMPLANTS 90053307SCR SYN 3.5MM LOCKING SL 1000278 OTHER IMPLANTS 90053308DRILL SYN QC 165MM 310.2 588270 MED-SUR SUPPLIES 90053309PL CONN ASTURA LAT ROD T 2000278 OTHER IMPLANTS 90053310ROD ASTURA HEX 6.0 500MM 2940278 OTHER IMPLANTS 90053311BO AMENDIA NEVOS DBM PUT 6125278 OTHER IMPLANTS 90053312BO AMENDIA NEVOS DBM FIB 6125278 OTHER IMPLANTS 90053313LOTUS SCR SP/ ELEMENTS POST CERVICAL 2925278 OTHER IMPLANTS 90053314LOTUS SCR SP/ ELEMENTS LOCKING 450278 OTHER IMPLANTS 90053315LOTUS ROD SP/ ELEMENTS POST CERVICAL 810278 OTHER IMPLANTS 90053317IM TITAN ENDOSKELETON TO 15000278 OTHER IMPLANTS 90053318PL OMNIA PRECISION/USA A 11500278 OTHER IMPLANTS 90053319SCR OMNIA PRECISION/USA 500278 OTHER IMPLANTS 90053320IM MED T2 ALTITUDE EXPAN 30000278 OTHER IMPLANTS 90053321SCR MED T2 ALTITUDE 25MM 1925278 OTHER IMPLANTS 90053322GUIDE PIN INTEGRITY FLAR 796270 MED-SUR SUPPLIES 90053323BO AMENDIA NEVOS DBM PUT 3063278 OTHER IMPLANTS 90053324IM ASTURA ZION CERVICAL 10850278 OTHER IMPLANTS 90053325DRILL ASTURA ZION CERVIC 691272 STERILE SUPPLY 90053326IM ASTURA ZION CERVICAL 6200278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053327BO SPGFT EXPANSE TISSUE 3000278 OTHER IMPLANTS 90053328IM FIREBIRD OFFSET CONNE 2000278 OTHER IMPLANTS 90053329ROD MED MRC 5.5MM OPEN 5 3825278 OTHER IMPLANTS 90053335IM MED HOOK LARGE EXTEND 3750270 MED-SUR SUPPLIES 90053336ROD OMNIA K2M COBALT CHR 2940278 OTHER IMPLANTS 90053337PL MED ZEVO CERV 81MM 30 3032278 OTHER IMPLANTS 90053338ROD MED SOLERA COBALT 60 1161278 OTHER IMPLANTS 90053339IM MED HOOK MEDIUM WIDE 4000278 OTHER IMPLANTS 90053340ROD MED MRC SIDE TO SIDE 3825278 OTHER IMPLANTS 90053341IM ASTURA ZION CERVICAL 9300278 OTHER IMPLANTS 90053342ROD MED SOLERA PREBENT T 1161278 OTHER IMPLANTS 90053344 BRAIN AND NERVE INTRAOPERATIVE MONITORIN 2000 270 MED-SUR SUPPLIES 90053345BRAIN & NERVE TCMEP MONITORING 400270 MED-SUR SUPPLIES 90053346IM SPI/ELE CONNECTOR MER 2000278 OTHER IMPLANTS 90053347SCR SPI/ELE ILIAC MERCUR 4500278 OTHER IMPLANTS 90053348SCR AMENDIA AL SZS 108-L 4500278 OTHER IMPLANTS 90053349SCR SET AMENDIA 108-8400 250278 OTHER IMPLANTS 90053351NEVRO SENZA IPG NIPG1500 91875278 OTHER IMPLANTS 90053352NEVRO SURGICAL LEAD 70MM 12500278 OTHER IMPLANTS 90053353NEVRO PATIENT REMOTE PTR 4000270 MED-SUR SUPPLIES 90053354NEVRO CHARGER CHGR1000 4000270 MED-SUR SUPPLIES 90053355ROD MED MRC 5.5- 5.5 CLO 4250278 OTHER IMPLANTS 90053356DJO COLD PAD LARGE (SUB) 77270 MED-SUR SUPPLIES 90053357MED NEURO SURESCAN W/ PA 82500278 OTHER IMPLANTS 90053358BO NUTECH FIBEROS 10CC D 6125278 OTHER IMPLANTS 90053359ROD STRYKER CP 45MM 1000278 OTHER IMPLANTS 90053360SCR STRYKER SET/ BLOCKER 250278 OTHER IMPLANTS 90053361IM ASTURA ZION CERVICAL 7750278 OTHER IMPLANTS 90053362SCR MED LAMINAR HOOK 775 3250278 OTHER IMPLANTS 90053364SCR ZIMMER TRICOR SI JOI 16750278 OTHER IMPLANTS 90053365SCR ZIMMER TRICOR SI JOI 16750278 OTHER IMPLANTS 90053366PIN ZIMMER TRICOR THREAD 400278 OTHER IMPLANTS 90053367PIN ZIMMER TRICOR EXCHAN 400278 OTHER IMPLANTS 90053368PIRANHA PL CERV 3 LEVEL 5300278 OTHER IMPLANTS 90053369SCR ASTURA ZION CERV ALL 500278 OTHER IMPLANTS 90053370SCR MED LAG CANNULATED 3 3170278 OTHER IMPLANTS 90053371MED NEURO PRIME BATTERY 70245278 OTHER IMPLANTS 90053372IM RTI STREAMLINE TL LUM 21000278 OTHER IMPLANTS 90053373BO OMNIA MORPHEUS BONE G 8985278 OTHER IMPLANTS 90053375SCR MED CANNULATED BALLA 6000278 OTHER IMPLANTS 90053376ROD MED MRC DOMINO CLOSE 4250278 OTHER IMPLANTS 90053377SCR NUV RELINE-O LUMBAR 3000278 OTHER IMPLANTS 90053378SCR NUV RELINE-O LUMBAR 250278 OTHER IMPLANTS 90053379ROD NUV RELINE-O TI LORD 750278 OTHER IMPLANTS 90053382SU SMITH NEPHEW OSTEORAP 1706278 OTHER IMPLANTS 90053383SU SMITH NEPHEW OSTEORAP 1706278 OTHER IMPLANTS 90053384SU SMITH NEPHEW OSTEORAP 1706278 OTHER IMPLANTS 90053385PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90053386BO GENSANO APEX DBM PUTT 3063278 OTHER IMPLANTS 90053389IM AESCULAP QUINTEX CERV 7750278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053390BO INTEGRITY BIONEST COR 5515278 OTHER IMPLANTS 90053391INTRAOPERATIVE MONITORIN 1100270 MED-SUR SUPPLIES 90053392BO GENSANO APEX DBM PUTT 6125278 OTHER IMPLANTS 90053393IM HOOK MED SOLERA 55411 3750278 OTHER IMPLANTS 90053394PL MED CROSSLINK 58MM X 2000278 OTHER IMPLANTS 90053395PL ASTURA OLYMPIC CROSS 2000278 OTHER IMPLANTS 90053396SCR ORT MODULAR NXG AL S 2875278 OTHER IMPLANTS 90053397ROD ORT NXG 1 LEVEL AL S 750278 OTHER IMPLANTS 90053398SCR ORT NXG CLOSURE TOP 250278 OTHER IMPLANTS 90053399SCR ORT NXG TOP LOADING 4278 OTHER IMPLANTS 90053400PL MED VERTEX AXIAL 3.5/ 3085278 OTHER IMPLANTS 90053401BO SPI/GFT PRECISION ALI 14250278 OTHER IMPLANTS 90053402PL ASTURA ZION CERVICAL 4750278 OTHER IMPLANTS 90053403ROD MED SOLERA CHROMALLO 774278 OTHER IMPLANTS 90053404IM CTL LUMBAR CONSTR 1 L 14000278 OTHER IMPLANTS 90053405INSPIRE IV IPG 3028 85500278 OTHER IMPLANTS 90053406INSPIRE STIMULATION LEAD 9750278 OTHER IMPLANTS 90053407INSPIRE PRESSURE SENSING 15250278 OTHER IMPLANTS 90053408INSPIRE SLEEP REMOTE 250 5600278 OTHER IMPLANTS 90053409INSPIRE PHYSICIAN PROGRA 9900270 MED-SUR SUPPLIES 90053410PATIENT FAN 5" FD05805 42270 MED-SUR SUPPLIES 90053411BO GENSANO DBM SPONGE ST 8500278 OTHER IMPLANTS 90053412DRILL UCSS 4.0MM 8730007 1200270 MED-SUR SUPPLIES 90053413SCR MED UCSS 34MM 873-03 3170278 OTHER IMPLANTS 90053414SCR MED UCSS 40MM 873-04 3170278 OTHER IMPLANTS 90053415ULRICH CASSETTE HEAD FOR 680270 MED-SUR SUPPLIES 90053416SU S/N TWINFIX ULTRA ANC 1581278 OTHER IMPLANTS 90053417AWL S/N TAPPERED 3.8MM 7 158270 MED-SUR SUPPLIES 90053418PL ASTURA ZION CERVICAL 5300278 OTHER IMPLANTS 90053419IM SPI/ELE MERCURY PARAL 4250278 OTHER IMPLANTS 90053420ROD INTEGRA NEWPORT MIS 2940278 OTHER IMPLANTS 90053421SU S/N TWINFIX ULTRA ANC 1150278 OTHER IMPLANTS 90053423ROD MED MRC SIDE TO SIDE 4250278 OTHER IMPLANTS 90053424PIRANHA PL CERV 4 LEVEL 5850278 OTHER IMPLANTS 90053425PL MED VIS/ ATL ELITE 72 3032278 OTHER IMPLANTS 90053428MED NEURO INTELLIS PERC 107500278 OTHER IMPLANTS 90053430INSTRUMENT NEVRO TUNNELI 416270 MED-SUR SUPPLIES 90053432PIN ASTURA ZION CERV FIX 200270 MED-SUR SUPPLIES 90053434IM LDR MOBI-C ARTIFICIAL 24750278 OTHER IMPLANTS 90053435PIN LDR DISTRACTION MOBI 200270 MED-SUR SUPPLIES 90053436ROD ASTURA OLYMPIC CO CR 2940278 OTHER IMPLANTS 90053437SCR ASTURA OLYMPIC ILIAC 4500278 OTHER IMPLANTS 90053438INTELLIS SINGLE TRIAL 3000278 OTHER IMPLANTS 90053439DJO COLD THERAPY UNIT (S 288270 MED-SUR SUPPLIES 90053440IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90053441ROD ASTURA OLYMPIC 6.0 C 2940278 OTHER IMPLANTS 90053442PL MED ZEVO CERV 69MM 30 3032278 OTHER IMPLANTS 90053443MED NEURO INTELLIS SURG 112500278 OTHER IMPLANTS 90053446MED NEURO INTELLIS LEADS 5500278 OTHER IMPLANTS 90053447BRACE KNEE IMMOBILIZER 140274 PROSTHETIC DEVICES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053449PL OMNIA ATOLL OCCIPITAL 21500278 OTHER IMPLANTS 90053450BO NUT DBM 2CC OCMP2 500278 OTHER IMPLANTS 90053451SCR OMNIA ALTUS LUM AL/S 4500278 OTHER IMPLANTS 90053452SCR OMNIA ALTUS SET 250278 OTHER IMPLANTS 90053453ROD OMNIA ALTUS AL/SZS 1470278 OTHER IMPLANTS 90053454PL OMNIA ALTUS CROSSLINK 2000278 OTHER IMPLANTS 90053482IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90053483BAG DECANTER 10-102 8270 MED-SUR SUPPLIES 90053484IV HEPARIN SODIUM 0.9% I 274270 MED-SUR SUPPLIES 90053487BOSTON SCIENTIFIC SC-103 115000278 OTHER IMPLANTS 90053488BOSTON SCIENTIFIC PASSIN 100270 MED-SUR SUPPLIES 90053489BOSTON SCIENTIFIC TUNNEL 400270 MED-SUR SUPPLIES 90053490ST JUDE 3660 TRIPOLE SC 99000278 OTHER IMPLANTS 90053491SU S/N TWINFIX ULTRA 5.5 1150278 OTHER IMPLANTS 90053492SCR ASTURA POST CERV POL 3250278 OTHER IMPLANTS 90053493SCR ASTURA POST CERV SET 500278 OTHER IMPLANTS 90053494ROD ASTURA POST CERV ALL 900278 OTHER IMPLANTS 90053495VANCOMYCIN FOR INJECTION 235270 MED-SUR SUPPLIES 90053496ROD LEG 55MM PRE BENT 86 1161278 OTHER IMPLANTS 90053497IV SODIUM CHLORIDE 0.9% 19270 MED-SUR SUPPLIES 90053498ROD MED SOLERA PREBENT T 1161278 OTHER IMPLANTS 90053499DRILL NU/SPI S LOC POST 860270 MED-SUR SUPPLIES 90053500BO AMENDIA NEVOS DBM FIB 5515278 OTHER IMPLANTS 90053501IM HD ALIF TITANIUM PEEK 40000278 OTHER IMPLANTS 90053505BUCKET COMMODE W/ LID 6/ 144270 MED-SUR SUPPLIES 90053506BROSELOW RED KIT OXYGEN DELIVERY 124270 MED-SUR SUPPLIES 90053507BROSELOW PURPLE KIT OXYGEN DELI 104270 MED-SUR SUPPLIES 90053508BROSELOW YELLOW KIT OXYGEN DELI 104270 MED-SUR SUPPLIES 90053509BROSELOW WHITE KIT OXYGEN DELI 104270 MED-SUR SUPPLIES 90053510BROSELOW BLUE KIT OXYGEN DELI 104270 MED-SUR SUPPLIES 90053511BROSELOW ORANGE KIT OXYGEN DELI 104270 MED-SUR SUPPLIES 90053512BROSELOW GREEN KIT OXYGEN DELIVERY 104270 MED-SUR SUPPLIES 90053513SU SMITH NEPHEW OSTEORAP 1706278 OTHER IMPLANTS 90053514PL MED ZEVO CERV 75MM 30 2780278 OTHER IMPLANTS 90053516NEVRO SINGLE LEAD TRIAL 3000278 OTHER IMPLANTS 90053517ST. JUDE TRIPOLE W/ PADD 90000278 OTHER IMPLANTS 90053518PL MED OCCIPITAL ADJUSTA 11825278 OTHER IMPLANTS 90053519SCR MED BONE 4.5 X 6MM 7 2180278 OTHER IMPLANTS 90053520IM ZIMMER TRINICA CERV 1 6200278 OTHER IMPLANTS 90053521SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053522SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053523PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90053524PL ASTURA ZION CERVICAL 4200278 OTHER IMPLANTS 90053525LMA AURA STRAIGHT SIZE 3 42270 MED-SUR SUPPLIES 90053526PL ASTURA POST CERV CROS 2000278 OTHER IMPLANTS 90053527PL MED VISION ELITE CERV 3032278 OTHER IMPLANTS 90053528BO AMENDIA NEVOS DBM FIB 3063278 OTHER IMPLANTS 90053529IM DEPUY SYNEX CORPECTOM 30000278 OTHER IMPLANTS 90053531IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90053532DRILL MED PRESTIGE 69750 500270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053533SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053534SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053535THERMOMETER TYMPAN GENIU 770270 MED-SUR SUPPLIES 90053536SODIUM CL IRRIG .9% 500M 211270 MED-SUR SUPPLIES 90053537ROD ASTURA LATERAL ROD C 2000278 OTHER IMPLANTS 90053538MED NEURO INTELLIS BATTERY 100000278 OTHER IMPLANTS 90053539MED NEURO SENSOR REPLACE 90000278 OTHER IMPLANTS 90053541BO GENSANO APEX DBM PUTT 1531278 OTHER IMPLANTS 90053542PASSPORT 12 DRYLINE AIRW 138270 MED-SUR SUPPLIES 90053543DATASCOPE 1 DRYLINE WATE 693270 MED-SUR SUPPLIES 90053544DATASCOPE 12 PRINTER PAP 163270 MED-SUR SUPPLIES 90053545SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053546ROD MED SOLERA 35MM 1555 774278 OTHER IMPLANTS 90053547IM MED T2 ALTITUDE EXPAN 46750278 OTHER IMPLANTS 90053548SCR MED T2 ALTITUDE LORD 3025278 OTHER IMPLANTS 90053549ROD ASTURA POST CERV 400 1800278 OTHER IMPLANTS 90053550BO OMNIA SUZUKA CERV PEE 2790278 OTHER IMPLANTS 90053552VAC TUBE LIGHT GREEN HEP 67270 MED-SUR SUPPLIES 90053553PL MED ZEVO CERV 43MM 30 3032278 OTHER IMPLANTS 90053554PL MED ZEVO CERV 65MM 30 2780278 OTHER IMPLANTS 90053555SCR ARTHREX 4.5 X 40MM A 3975278 OTHER IMPLANTS 90053556K-WIRE ARTHREX 2.0 AR-89 100270 MED-SUR SUPPLIES 90053557DRILL ARTHREX CANNULATED 700270 MED-SUR SUPPLIES 90053559IM AES MODULIFT SIZE L E 4765278 OTHER IMPLANTS 90053560SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053561ARTLINE ADAPTER CORD PAC 920270 MED-SUR SUPPLIES 90053562ROD MED SOLERA 90MM TITA 1161278 OTHER IMPLANTS 90053563IM ARTHREX ANATOEMIC PHA 3475278 OTHER IMPLANTS 90053564SCR ARTHREX QUICKFIX 2.0 1200278 OTHER IMPLANTS 90053565ROD ASTURA TRANSITION 4. 2940278 OTHER IMPLANTS 90053566SU ART FIBERWIRE 2-0 AR- 88270 MED-SUR SUPPLIES 90053567SPLINT ORTHO GLASS 4 INC 32270 MED-SUR SUPPLIES 90053568BO GENSANO APEX DBM PUTT 950278 OTHER IMPLANTS 90053569SCR LEG 7.5 X 30MM 75447 2776278 OTHER IMPLANTS 90053571SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053572SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053575IM AESCULAP QUINTEX CERV 6200278 OTHER IMPLANTS 90053576IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90053577SCR ARTHREX MINI FT 3.5 2500278 OTHER IMPLANTS 90053578DRILL ARTHREX MINI PROFI 600270 MED-SUR SUPPLIES 90053579DRILL BIT ARTHREX CANNUL 780270 MED-SUR SUPPLIES 90053580GUIDEWIRE ARTHREX .045 A 126272 STERILE SUPPLY 90053581GUIDEWIRE ARTHREX .062 A 86272 STERILE SUPPLY 90053582SCR ARTHREX MINI SCORPIO 4750278 OTHER IMPLANTS 90053583SCR ARTHREX QUICKFIX 2.0 1200278 OTHER IMPLANTS 90053584IM ARTHREX ANATOEMIC PHA 3475278 OTHER IMPLANTS 90053585PURELL VERSAHOLD BRACKET 267270 MED-SUR SUPPLIES 90053586PL CTL CERVICAL 2 LEVEL 4750278 OTHER IMPLANTS 90053587SCR CTL CERVICAL ALL SIZ 500278 OTHER IMPLANTS 90053588SPLINT FOOT DROP LARGE R 160270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053589ROD MED 6.5 CLOSED 5.5 O 4250278 OTHER IMPLANTS 90053590SCR ARTHREX 4.5 X 50MM A 3975278 OTHER IMPLANTS 90053591SCR ARTHREX QUICKFIX 2.0 1200278 OTHER IMPLANTS 90053593MODULE NUVASIVE NVM5 NEX 3697270 MED-SUR SUPPLIES 90053595NEVRO BLUE PERC LEAD KIT 2500278 OTHER IMPLANTS 90053596SCR ARTHREX QUICKFIX 2.0 1200278 OTHER IMPLANTS 90053597DRILL ARTHREX STANDARD P 600270 MED-SUR SUPPLIES 90053598DRILL ARTHREX 3.2 CANNUL 780270 MED-SUR SUPPLIES 90053599SCR ARTHREX 4.0 HEADLESS 2110278 OTHER IMPLANTS 90053600SCR ARTHREX 4.0 HEADLESS 2110278 OTHER IMPLANTS 90053601SCR ARTHREX 4.0 HEADLESS 2110278 OTHER IMPLANTS 90053602SCR MED CANNULATED BALLA 6000278 OTHER IMPLANTS 90053603ROD MED SOLERA 5.5MM COB 1000278 OTHER IMPLANTS 90053604BO GENSANO APEX CRUNCH D 6125278 OTHER IMPLANTS 90053605BO GENSANO APEX CRUNCH D 3063278 OTHER IMPLANTS 90053606SCR MED CANNULATED BALLA 6000278 OTHER IMPLANTS 90053608DIAPERS ADULT PULL UP 11270 MED-SUR SUPPLIES 90053609SCR MED T2 ALTITUDE 6.5 3000278 OTHER IMPLANTS 90053610PL MED ROASTRAL STAPLE 9 6250278 OTHER IMPLANTS 90053611PL MED CAUDAL STAPLE 933 6250278 OTHER IMPLANTS 90053612IM MED T2 ALTITUDE CAGE 30000278 OTHER IMPLANTS 90053613SCR MED 4 DEGREE END CAP 3025278 OTHER IMPLANTS 90053614PL MED VANTAGE 5.5MM 933 17500278 OTHER IMPLANTS 90053615SCR MED LOCKING NUT 9330 1300278 OTHER IMPLANTS 90053616IM ULRICH UNION CERVICAL 6200278 OTHER IMPLANTS 90053621KIT CHEST TUBE INSERTION 507270 MED-SUR SUPPLIES 90053622IM ONE SURG LUM 3 LVL CON 28000278 OTHER IMPLANTS 90053623SCR ONE SURGICAL CERV AL 500278 OTHER IMPLANTS 90053624PL ONE SURGICAL CERV 3 L 5300278 OTHER IMPLANTS 90053625SCRUB BRUSH WITH BETADIN 122270 MED-SUR SUPPLIES 90053626FIXATION PIN ONE SURGICA 296272 STERILE SUPPLY 90053627IM ONE SURG CERV 1 LVL CON 5580278 OTHER IMPLANTS 90053628BO SEA SPINE ACCELL EVO 1829278 OTHER IMPLANTS 90053629BO SEA SPINE ACCELL EVO 3240278 OTHER IMPLANTS 90053630BO SEA SPINE ACCELL EVO 5670278 OTHER IMPLANTS 90053631BO SEA SPINE ACCELL EVO 10530278 OTHER IMPLANTS 90053632BO SEA SPINE ISOTIS STRA 2090278 OTHER IMPLANTS 90053633BO SEA SPINE ISOTIS STRA 4013.1278 OTHER IMPLANTS 90053634BO SEA SPINE ISOTIS STRA 7023278 OTHER IMPLANTS 90053635BO SEA SPINE ISOTIS STRA 13043278 OTHER IMPLANTS 90053636BO SEA SPINE BALLAST 45 4500278 OTHER IMPLANTS 90053637BO SEA SPINE BALLAST 85 10650278 OTHER IMPLANTS 90053639IM ULRICH CAGE VBR SMALL 27100278 OTHER IMPLANTS 90053640IM ONE SURG CERV 2 LVL CON 6975278 OTHER IMPLANTS 90053641PL ULRICH UNION CERVICAL 4750278 OTHER IMPLANTS 90053642SCR ULRICH CERVICAL FIXA 500278 OTHER IMPLANTS 90053643IM ONE SURG CERV 3 LVL CON 8370278 OTHER IMPLANTS 90053644 TAURUS SCR INTEGRITY CANNULATED SCREWS 4000 278 OTHER IMPLANTS 90053645TAURUS SCR HEADBODY ASSEMBLY 450278 OTHER IMPLANTS 90053646TAURUS SCR INTEGRITY SET SCREWS 225278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053647TAURUS ROD INTEGRITY LUMBAR 1325278 OTHER IMPLANTS 90053648IM INTEGRITY FLAREHAWK S 5000278 OTHER IMPLANTS 90053649KIT NEVRO LEAD ANCHOR N3 625270 MED-SUR SUPPLIES 90053650NEEDLE EPIMED CURVED TIP 300270 MED-SUR SUPPLIES 90053651IM ONE SURG LUM 2 LVL CON 18900278 OTHER IMPLANTS 90053652ADAPTER/FITTING PORT FOR 67270 MED-SUR SUPPLIES 90053653PL MED ZEVO CERV 105MM 3 3032278 OTHER IMPLANTS 90053654SCR UCENTUM POLYAXIAL AL 4500278 OTHER IMPLANTS 90053655SCR UCENTUM LOCKING CS 3 250278 OTHER IMPLANTS 90053656ROD UCENTUM PRE BENT ALL 1470278 OTHER IMPLANTS 90053657IV HEPARIN SODIUM PORCIN 285270 MED-SUR SUPPLIES 90053658OTOSCOPE SPECULA FOR MAC 104270 MED-SUR SUPPLIES 90053659PL ACUMED LATERAL DISTAL 6325278 OTHER IMPLANTS 90053660PL ACUMED MEDIAL DISTAL 6325278 OTHER IMPLANTS 90053661PLATE TAP ACUMED FOR 3.0 1692278 OTHER IMPLANTS 90053662CAPE EXAM PAT TESTING 30 4270 MED-SUR SUPPLIES 90053663ROD MED 5.5MM TITANIUM C 1000278 OTHER IMPLANTS 90053664IV ADVANTAGE 0.9% NORMAL 171270 MED-SUR SUPPLIES 90053665INFINITY DRILL MED 2.4MM 864270 MED-SUR SUPPLIES 90053666INFINITY SCR MED POST CERVICAL 2925278 OTHER IMPLANTS 90053667INFINITY SCR MED SET LOCKING 450278 OTHER IMPLANTS 90053668INFINITY ROD MED POST CERVICAL 810278 OTHER IMPLANTS 90053669PL NUVASIVE DECADE XLIF 15000278 OTHER IMPLANTS 90053670SCR NUVASIVE DECADE XLIF 4275278 OTHER IMPLANTS 90053671BO AMENDIA NEVOS DBM PUT 6125278 OTHER IMPLANTS 90053672SCR ONE SURGICAL LUMBAR 2486.25278 OTHER IMPLANTS 90053673ROD ONE SURGICAL LUMBAR 877.5278 OTHER IMPLANTS 90053674SCR ONE SURGICAL SET LUM 450278 OTHER IMPLANTS 90053675FAST FIND GRID CT BIOPSI 540270 MED-SUR SUPPLIES 90053676STENT BOSTON SCIENTIFIC 923270 MED-SUR SUPPLIES 90053677GUIDEWIRE BOSTON SCIENTI 633.36272 STERILE SUPPLY 90053678GUIDEWIRE BOSTON SCIENTI 103272 STERILE SUPPLY 90053679SU S/N TWINFIX ULTRA 4.5 1150278 OTHER IMPLANTS 90053680DISPENSER EMESIS BAG NS3 316270 MED-SUR SUPPLIES 90053681NEEDLE COUNTER FOAM 15 C 67270 MED-SUR SUPPLIES 90053682SUTURE PASSER 2" 7220140 137270 MED-SUR SUPPLIES 90053683MED NEURO EXTENSION KIT 2724278 OTHER IMPLANTS 90053684TUBE GREINER 2.7ML 3.2% 16270 MED-SUR SUPPLIES 90053685ROD ASTURA 5.5 COCR 500M 2940278 OTHER IMPLANTS 90053686BO AMENDIA ALLOS CERV SP 2790278 OTHER IMPLANTS 90053688PL MED VIS/ ELITE CERV 6 3032278 OTHER IMPLANTS 90053689PL MED INFINITY POST CER 3085278 OTHER IMPLANTS 90053690IM CTL LUMBAR CONSTR 2 L 21000278 OTHER IMPLANTS 90053691BO SEA SPINE BALLAST 85 7500278 OTHER IMPLANTS 90053693LMA CARDINAL SINGLE USE 65270 MED-SUR SUPPLIES 90053694LMA CARDIANL ONE USE SIZ 59270 MED-SUR SUPPLIES 90053695LMA CARDIANL ONE USE SIZ 59270 MED-SUR SUPPLIES 90053696INJECTION 0.9% SODIUM CH 10270 MED-SUR SUPPLIES 90053697SWANSON FLEXSPAN FLEXIBL 5728278 OTHER IMPLANTS 90053699DRILL CTL MEDICAL ALL SI 691270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053700ST JUDE 3228 CONTROL SY 79200278 OTHER IMPLANTS 90053701SCR ARTHREX MINI FT 3.5 2500278 OTHER IMPLANTS 90053702REAMER ARTHREX CIRCULAR 1800270 MED-SUR SUPPLIES 90053703REAMER ARTHREX METATARSA 1800270 MED-SUR SUPPLIES 90053704REAMER ARTHREX PHALANGEA 1800270 MED-SUR SUPPLIES 90053705SCR MED CANNULATED BALLA 6000278 OTHER IMPLANTS 90053706PHARM PCA STERILE EMPTY 31270 MED-SUR SUPPLIES 90053707MED NEURO REMOTE CONTROL 3180270 MED-SUR SUPPLIES 90053709DIAPER ADULT SIDE STRAP 9270 MED-SUR SUPPLIES 90053710DIAPER PED ADULT 11270 MED-SUR SUPPLIES 90053711IM ZIMMER VITALITY LUM 1 14000278 OTHER IMPLANTS 90053712IM CTL CERVICAL 4 LEVEL 10850278 OTHER IMPLANTS 90053713BO GENSANO CANC CHIPS CR 1750278 OTHER IMPLANTS 90053714PL MED VIS/ ATL ELITE CE 3032278 OTHER IMPLANTS 90053715ROD MED DOMINO CONNECTOR 4250278 OTHER IMPLANTS 90053716GUIDEWIRE MEDTRONIC 8670 220272 STERILE SUPPLY 90053717ROD MED SOLERA 60MM 1553 1161278 OTHER IMPLANTS 90053718SCR AES ENNOVATE LUMBAR 4000278 OTHER IMPLANTS 90053719SCR AES ENNOVATE SET LOC 250278 OTHER IMPLANTS 90053720ROD AES ENNOVATE ALL SIZ 1470278 OTHER IMPLANTS 90053721IM OMNIA FUJI CERVICAL 2 7750278 OTHER IMPLANTS 90053723BO GENSANO CANCELLOUS CH 875278 OTHER IMPLANTS 90053724PHARM IV SOD CHL 0.9% 25 171270 MED-SUR SUPPLIES 90053725DRAPE CT CONTROLS BAND B 134270 MED-SUR SUPPLIES 90053726PL OMNIA FUJI CERVICAL 3 5300278 OTHER IMPLANTS 90053727SCR OMNIA FUJI CERVICAL 500278 OTHER IMPLANTS 90053728WIRE SYN KIRSCHNER W/ TR 664270 MED-SUR SUPPLIES 90053729PL SYN LCP PROXIMAL HUME 14205278 OTHER IMPLANTS 90053730SCR SYN 3.5 LOCKING ST 1145278 OTHER IMPLANTS 90053731SCR SYN 3.5MM LOCKING ST 1145278 OTHER IMPLANTS 90053732SCR SYN 3.5MM LOCKING ST 1145278 OTHER IMPLANTS 90053733SCR SYN 3.5MM LOCKING ST 1145278 OTHER IMPLANTS 90053734SCR SYN 3.5MM LOCKING ST 1145278 OTHER IMPLANTS 90053735SCR SYN 3.5MM LOCKING ST 1145278 OTHER IMPLANTS 90053736SCR SYN CORTEX 28MM 204 225278 OTHER IMPLANTS 90053737SCR SYN 3.5MM LOCKING ST 1145278 OTHER IMPLANTS 90053738WIRE SYN KIRSCHNER TROCA 664270 MED-SUR SUPPLIES 90053739LUMBAR PUNCTURE TRAY 20G 748270 MED-SUR SUPPLIES 90053740NE 24G X 5IN GERTIE MARX 502270 MED-SUR SUPPLIES 90053741NE 25G X 3.5IN GERTIE MA 413270 MED-SUR SUPPLIES 90053742SPLINT LARGE LEFT FOOT D 200270 MED-SUR SUPPLIES 90053745MED NEURO WIRELESS EXTER 5200270 MED-SUR SUPPLIES 90053748SPINAL MANOMETER 001151- 420270 MED-SUR SUPPLIES 90053753STOPCOCK CLEARTRAC CANNU 22270 MED-SUR SUPPLIES 90053756BO ONE SURGICAL CERV SPA 3100278 OTHER IMPLANTS 90053757SUTURE PASSER FIRSTPASS 900270 MED-SUR SUPPLIES 90053758BO GENSANO CANCELLOUS CH 2365278 OTHER IMPLANTS 90053759SURGIFOAM PORCINE GEL PO 1303270 MED-SUR SUPPLIES 90053760ROD MED SOLERA CHROMALLO 1161278 OTHER IMPLANTS 90053761SCR OMNIA POSTERIOR CERV 3250278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053762ROD OMNIA POSTERIOR CERV 900278 OTHER IMPLANTS 90053763SCR OMNIA POSTERIOR CERV 500278 OTHER IMPLANTS 90053764SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053765GLOVES NUAIRE PHARMACY B 160270 MED-SUR SUPPLIES 90053766PL INTEGRITY TAURUS CROS 1800278 OTHER IMPLANTS 90053767PL MED OCCIPITAL CROSSLI 2000278 OTHER IMPLANTS 90053768ROD SPI/ELE MERCURY TOTA 1000278 OTHER IMPLANTS 90053770GLOVE NEOPRINE 7.5 DANIELLE 5270 MED-SUR SUPPLIES 90053771GL NEOPRINE 7 DANIELLE 5270 MED-SUR SUPPLIES 90053772SCR SPINAL ELE OVERWATCH 2775278 OTHER IMPLANTS 90053773SCR SPINAL ELE OVERWATCH 250278 OTHER IMPLANTS 90053774ROD SPINAL ELE OVERWATCH 1470278 OTHER IMPLANTS 90053775PL SPINAL ELE OVERWATCH 1800278 OTHER IMPLANTS 90053776GOWN 2XL LONG C WHITE 9 20270 MED-SUR SUPPLIES 90053777MAXIMOVE XL SLINGS MFA10 1720270 MED-SUR SUPPLIES 90053778GLIDESCOPE BFLEX SINGLE 1180270 MED-SUR SUPPLIES 90053779PL ONE SURGICAL CERV 2 L 4750278 OTHER IMPLANTS 90053780CONNECTOR ASTURA INLINE 1800278 OTHER IMPLANTS 90053781CONNECTOR ASTURA STD CLO 2000278 OTHER IMPLANTS 90053782SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053785PL MED ATL/ ELITE 67MM 7 3032278 OTHER IMPLANTS 90053792ZAVATION MENDEC AQUA DEL 2000270 MED-SUR SUPPLIES 90053793KIT ZAVATION BONE ACCESS 2000270 MED-SUR SUPPLIES 90053794KIT ZAVATION CEMENT DELI 1750270 MED-SUR SUPPLIES 90053795ZAVATION MENDEC HV CEMEN 1750278 OTHER IMPLANTS 90053796ONCONTROL POWER DRIVER W 2276270 MED-SUR SUPPLIES 90053798SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053799SCR SYNTHES 3.5 CANNULAT 1780278 OTHER IMPLANTS 90053800SCR SYNTHES 3.5 CANNULAT 1780278 OTHER IMPLANTS 90053801GUIDE WIRE SYNTHES 1.25M 224272 STERILE SUPPLY 90053802SCR MED CANNULATED BALLA 6000278 OTHER IMPLANTS 90053803ROD MED DOMINO VARIABLE 5250278 OTHER IMPLANTS 90053804IM NUVASIVE MODULUS XLW 28783278 OTHER IMPLANTS 90053805PL NUVASIVE MODULUS XLIF 17500278 OTHER IMPLANTS 90053806SCR NUVASIVE COROENT XLI 6150278 OTHER IMPLANTS 90053807KIT NUVASIVE MAXCESS ACC 5525270 MED-SUR SUPPLIES 90053808PL OMNIA SPINOUS PROCESS 29750278 OTHER IMPLANTS 90053809PL OMNIA SPINOUS PROCESS 29750278 OTHER IMPLANTS 90053811PL MED VIS/ ATL ELITE 19 3032278 OTHER IMPLANTS 90053814PL OMNIA ILIAC OFFSET CO 2000278 OTHER IMPLANTS 90053824BO ORTHO REBIRTH REBOSSI 10000278 OTHER IMPLANTS 90053825BO ORTHO REBIRTH REBOSSI 18000278 OTHER IMPLANTS 90053826PL MED ZEVO CERV 31MM 30 3032278 OTHER IMPLANTS 90053827SJM PENTA PADDLE NERVE S 22500278 OTHER IMPLANTS 90053828MED NEURO INTELLIS LT 97 95000278 OTHER IMPLANTS 90053829PL OMNIA MONZA CERV 1 LE 4200278 OTHER IMPLANTS 90053830TAURUS SCR INTEGRITY POLYAXAL 2500278 OTHER IMPLANTS 90053831BO ORTHO REBIRTH REBOSSI 7200278 OTHER IMPLANTS 90053832BACK BRACE EXOS FORM II 900274 PROSTHETIC DEVICES 90053833SCR ILIAC SPINAL ELEMENTS OVERWATCH 4050278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053834PL SPINAL ELE CLOSED OPE 1800278 OTHER IMPLANTS 90053837IM MED TRANSVERSE PROCES 3750278 OTHER IMPLANTS 90053838SCR MED 22M 8 DEGREE END 3025278 OTHER IMPLANTS 90053839SCR MED 22MM 4 DEGREE EN 3025278 OTHER IMPLANTS 90053840IM MED T2 ALTITUDE EXPAN 46750278 OTHER IMPLANTS 90053841ROD COCR CORAL HEX END S 2940278 OTHER IMPLANTS 90053842BO ORTHO REBIRTH REBOSSI 4000278 OTHER IMPLANTS 90053843PL ACUMED MEDIAL DISTAL 6880278 OTHER IMPLANTS 90053844PL ACUMED LATERAL DISTAL 6880278 OTHER IMPLANTS 90053845SCR ACUMED 2.7MM NON-LOC 450278 OTHER IMPLANTS 90053846SCR ACUMED 3.0MM NON-LOC 450278 OTHER IMPLANTS 90053847SCR ACUMED 3.0MM LOCKING 750278 OTHER IMPLANTS 90053848SCR ACUMED 3.5MM NON-LOC 450278 OTHER IMPLANTS 90053849BONE TAP ACUMED 3.0MM HE 912278 OTHER IMPLANTS 90053850SCR MED LEGACY 6.35 5.0 2776278 OTHER IMPLANTS 90053851SCR MED LEGACY 6.35 5.5 2776278 OTHER IMPLANTS 90053852SCR MED LEGACY 6.35 5.5 2776278 OTHER IMPLANTS 90053853SCR MED LEGACY 6.35 5.5 2776278 OTHER IMPLANTS 90053854SCR MED LEGACY 6.35 6.5 2776278 OTHER IMPLANTS 90053855SCR MED LEGACY 6.35 6.5 2776278 OTHER IMPLANTS 90053856SCR MED LEGACY 6.35 6.5 2776278 OTHER IMPLANTS 90053857SCR MED LEGACY 6.35 6.5 2776278 OTHER IMPLANTS 90053858ROD MED LEGACY 6.35MM 96 1000278 OTHER IMPLANTS 90053859PIRANHA PL CERV 1 LEVEL 4200278 OTHER IMPLANTS 90053860MED NEURO INTELLIS LT 97 100000278 OTHER IMPLANTS 90053861SU SMITH NEPHEW OSTEORAP 1706270 MED-SUR SUPPLIES 90053862IM MED LAMINAR HOOK LEFT 3750278 OTHER IMPLANTS 90053863SCS ABBOTT PROCLAIM 7 EL 90000278 OTHER IMPLANTS 90053864CABLE ECG FOR DPM4 MINDR 160270 MED-SUR SUPPLIES 90053865CABLE 5 LEAD FOR ECG DPM 136270 MED-SUR SUPPLIES 90053866PROFEND NASAL DECOLONIZA 4166270 MED-SUR SUPPLIES 90053867CABLE ECG FOR DPM7 0010- 222270 MED-SUR SUPPLIES 90053868CABLE SPO2 FOR DPM7 0010 829270 MED-SUR SUPPLIES 90053869CABLE IBP (ART LINE ) FO 474270 MED-SUR SUPPLIES 90053870CRUTCHES ADULT TALL 7771 41270 MED-SUR SUPPLIES 90053873KIT ZAVATION 10G KYPHO K 8600270 MED-SUR SUPPLIES 90053874FLOWONIX PROMETRA II PUM 47600278 OTHER IMPLANTS 90053875FLOWONIX INTRATHECAL CAT 2750278 OTHER IMPLANTS 90053876FLOWONIX PATIENT THERAPY 2200270 MED-SUR SUPPLIES 90053877SCR MED CANNULATED BALLA 6000270 MED-SUR SUPPLIES 90053878MED NEURO INTELLIS LT 97 85000278 OTHER IMPLANTS 90053881FLOWONIX CATHETER REVISI 1500278 OTHER IMPLANTS 90053882NEVRO BLUE PERC LEAD KIT 2500278 OTHER IMPLANTS 90053883GEL-FLOW NT PHARMACY 000 1320270 MED-SUR SUPPLIES 90053884ROD ASTURA OLYMPIC LATER 2000278 OTHER IMPLANTS 90053885SCR MED SOLERA CANNULATE 6000278 OTHER IMPLANTS 90053886SCR MED MRC AXIAL SET SC 4278 OTHER IMPLANTS 90053887IM MED T2 ALTITUDE 19MM 30000278 OTHER IMPLANTS 90053888PL MED T ALTITUDE 4 DEG 3025278 OTHER IMPLANTS 90053889IM ULRICH VBR CAGE SMALL 27100278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053890PL MED 10MM LATERAL CLOS 2000278 OTHER IMPLANTS 90053891PL MED 10MM LATERAL OPEN 2000278 OTHER IMPLANTS 90053892SCR MED FLAT CONNECTOR S 250278 OTHER IMPLANTS 90053894MED KIT DUAL TIP LIGHT S 2336270 MED-SUR SUPPLIES 90053895PL OMNIA CORAL OFFSET OP 1800270 MED-SUR SUPPLIES 90053896IM ONE SURGICAL ECHO XL 6750278 OTHER IMPLANTS 90053899 BO GENSANO CANCELLOUS CHIPS 30CC CCH-410 1050 278 OTHER IMPLANTS 90053906PL MED CLOSED ROD CONNECTOR 3601550 2750278 OTHER IMPLANTS 90053920SCR OMN VAL NON CAN AL/SZS 3000278 OTHER IMPLANTS 90053925ABBOTT NEURO PROCLAIM ELITE SCS 112500278 OTHER IMPLANTS 90053928 BO AMENDIA NEVOS DBM FIBER PUTTY 5CC BNF 3062.5 278 OTHER IMPLANTS 90053929 STIMWAVE FREEDOM-8A TRIAL LEAD FR8A-TRI- 1250 278 OTHER IMPLANTS 90053930 STIMWAVE FREEDOM-8A TRIAL LEAD FR8A-TRI- 1250 278 OTHER IMPLANTS 90053934 BO AMEN/ SPI HERO PUTTY DBM PLUS 10CC 01 1225 278 OTHER IMPLANTS 90053935IM RTI CERVICAL 1 LEVEL CONSTRUCT 6200278 OTHER IMPLANTS 90053939PL ACUMED 8 HOLE MIDSHAFT UINA 70-0071 4695278 OTHER IMPLANTS 90053940 SCR ACUMED 3.5 X 16MM NON LOCKING 30-025 450 278 OTHER IMPLANTS 90053941 SCR ACUMED 3.5 X 20MM NON LOCKING 30-026 450 278 OTHER IMPLANTS 90053942SCR ACUMED 3.5 X 16MM LOCKING 30-0236 750278 OTHER IMPLANTS 90053943STIMWAVE STIMQ NEUROSTIMULATOR 75000278 OTHER IMPLANTS 90053944SCR VALENCIA N/CANNULATED ALL SIZES 3000278 OTHER IMPLANTS 90053945BO NEVOS DBM FIBER PUTTY 5CC 3063278 OTHER IMPLANTS 90053946VALENCIA IM OMN 1 LEVEL CONST 12600278 OTHER IMPLANTS 90053947SCR STRYKER POLY ALL SIZES 2775278 OTHER IMPLANTS 90053948BOXCAR VBR CAGE 18301.25278 OTHER IMPLANTS 90053949BOXCAR END CAP 0 DEGREES 2129.25278 OTHER IMPLANTS 90053950BOXCAR END CAP 7.5 DEGREES 1925278 OTHER IMPLANTS 90053951BOXCAR END PLATE 2.5 DEGREES 3025278 OTHER IMPLANTS 90053952BOXCAR END PLATE 5 DEGREES 3025278 OTHER IMPLANTS 90053953BOXCAR PEEK 23MM 15000278 OTHER IMPLANTS 90053954HOOK MED TRANSVERSE SMALL 5441123 3750278 OTHER IMPLANTS 90053955SOLERA ROD 40MM CHROMALLOY 1000278 OTHER IMPLANTS 90053956BOXCAR END CAP 7.5 DEGREES 1925278 OTHER IMPLANTS 90053957BOXCAR END CAP 5 DEGREES 1925278 OTHER IMPLANTS 90053958PL ACUMED CLAVICAL 8 HOLE 6005278 OTHER IMPLANTS 90053959SCR CORTICAL 2.3 X 16 655278 OTHER IMPLANTS 90053960SCR CORTICAL 2.3 X 18 655278 OTHER IMPLANTS 90053961SCR NON LOCKING 3.5 X 12 655278 OTHER IMPLANTS 90053962SCR LOCKING 3.5 X 10 655278 OTHER IMPLANTS 90053963SCR LOCKING 3.5 X 12 655278 OTHER IMPLANTS 90053965NE COUDE 4IN 107-1314 176272 STERILE SUPPLY 90053966NEVRO SENZA IPG NIPG2000 91875278 OTHER IMPLANTS 90053967INFINITY DOMINO 5.5/ 3.5 2000278 OTHER IMPLANTS 90053968PL MED CLOSED ROD CONNECTOR 3601550 2750278 OTHER IMPLANTS 90053969SU S/N TWINFIX ULTRA 4.5 1150278 OTHER IMPLANTS 90053970IM GENSANO 4X6 XPLUS MEMBRANE 6250278 OTHER IMPLANTS 90053971 PL ACUMED NARROW PROFILE 8 HOLE STRAIGHT 6880 278 OTHER IMPLANTS 90053972SCR 3.5 X 12 NON LOCKING 655278 OTHER IMPLANTS 90053973SCR 3.5 X 10 LOCKING 655278 OTHER IMPLANTS 90053974SCR 3.5 X 12 LOCKING 655278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90053975SCR 3.5 X 14 LOCKING 655278 OTHER IMPLANTS 90053976SCR 2.7 X 18 NON LOCKING 655278 OTHER IMPLANTS 90053977DRILL BIT 2.0 X 5 QUICK RELEASE 432272 STERILE SUPPLY 90053978INFINITY CROSSLINK POST CERV 3085278 OTHER IMPLANTS 90053979IM ALPH ARSENAL LUMBAR 2 LEVEL 18900278 OTHER IMPLANTS 90053980LOCALIZERS DIAGNOSTIC CT SKIN MARKERS 4270 MED-SUR SUPPLIES 90053981INFINITY ROD MED POST CERVICAL 3605240 810278 OTHER IMPLANTS 90053982SCR LEG 5.5 X 40 75445545 2776.3278 OTHER IMPLANTS 90053983INTRACEPT FLEXIBLE BI-POLAR RF PROBE 17680270 MED-SUR SUPPLIES 90053984INTRACEPT ACCESS INSTRUMENTS 7520270 MED-SUR SUPPLIES 90053985 INTRACEPT ACCESS INSTRUMENTS ADDITIONAL 2800 270 MED-SUR SUPPLIES 90053986INTRACEPT RF GENERATOR RENTAL 1100270 MED-SUR SUPPLIES 90053987SCR NUV COROENT XLF 5485540 5975278 OTHER IMPLANTS 90053988NE NUV NVM5 IOM SSEP/ EM 3697.28270 MED-SUR SUPPLIES 90053989KIT NUVASIVE MAXCESS 3241000 5525272 STERILE SUPPLY 90053990MED LAMINAR HOOK 7756073 3250278 OTHER IMPLANTS 90053991SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90053992TOBRA BONE BASKET BB-100 107270 MED-SUR SUPPLIES 90053993BIONEST DBM PUTTY 10CC 5515278 OTHER IMPLANTS 90053994BIONEST DBM PUTTY 5CC 2755278 OTHER IMPLANTS 90053995LINE SIDER SCREW CANNULATED POLY 3600278 OTHER IMPLANTS 90053996LINE SIDER SCR HEADBODY ASSEMBLY 450278 OTHER IMPLANTS 90053997LINE SIDER SCR SET SCREWS 225278 OTHER IMPLANTS 90053998LINE SIDER ROD 500MM LUMBAR 2650278 OTHER IMPLANTS 90053999LINE SIDER ROD LUMBAR 1325278 OTHER IMPLANTS 90054000SCR MED LEGACY 7.5 X 45MM 2776278 OTHER IMPLANTS 90054001SCR MED LEGACY 7.5X 50MM 2776278 OTHER IMPLANTS 90054002SCR MED LEGACY 7.5X 55MM 2776278 OTHER IMPLANTS 90054003SCR MED LEGACY 8.5X 45MM 2776278 OTHER IMPLANTS 90054004SCR MED LEGACY 8.5X 50MM 2776278 OTHER IMPLANTS 90054005SCR MED LEGACY 8.5X 55MM 2776278 OTHER IMPLANTS 90054006SCR MED LEGACY 8.5X 60MM 2776278 OTHER IMPLANTS 90054007ROD SP/EL O/WATCH 500 2940278 OTHER IMPLANTS 90054008LMA SIZE 2 SINGLE USE 65270 MED-SUR SUPPLIES 90054009LOTUS OFFSET CONNECTOR POST CERV 900278 OTHER IMPLANTS 90054010LINE SIDER OFFSET CONNECTOR 1800278 OTHER IMPLANTS 90054011LINE SIDER ILIAC BOLT 3600278 OTHER IMPLANTS 90054012LINE SIDER CONNECTOR SET SCREW 225278 OTHER IMPLANTS 90054013BO OMNIA MORPH 3CC 2690278 OTHER IMPLANTS 90054014 VALENCIA IM OMNIA LUMBAR 3 LEVEL CONST 25200 278 OTHER IMPLANTS 90054015INVICTUS SCR ALP LUMBAR ALL SIZES 3375278 OTHER IMPLANTS 90054016INVICTUS SCR ALP SET 500278 OTHER IMPLANTS 90054017INVICTUS ROD ALP COCR 1000278 OTHER IMPLANTS 90054018PL ALP AXIAL CONNECTOR 2000278 OTHER IMPLANTS 90054019ROD SOLERA 80MM PREBENT COBALT 1000278 OTHER IMPLANTS 90054020 ROD MED 6.5 OPEN 5.5 CLOSED MRC AXIAL CO 4250 278 OTHER IMPLANTS 90054021FIXXSURE PURPLE X LINK 1800278 OTHER IMPLANTS 90054022NE 22G X 5IN GERTIE MARX 502270 MED-SUR SUPPLIES 90054023ABBOTT 2 LEAD TRIAL 3000278 OTHER IMPLANTS 90054024NE 22G X 5IN GERTIE MARX 502270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90054025LENEVA 3CC ALLOGRAFT MATRIX 10925278 OTHER IMPLANTS 90054026ROD 5.5MM TITANIUM 1555200500 774278 OTHER IMPLANTS 90054031TITAN CERVICAL TCS PEEK 6 DEGREE MED 20000278 OTHER IMPLANTS 90054032TITAN CERVICAL SCREW 3.5X14 1000278 OTHER IMPLANTS 90054033TITAN CERVICAL SCREW 3.5X16 1000278 OTHER IMPLANTS 90054034SOLERA 7.5 X 40MM DOUBLE HEAD 7500278 OTHER IMPLANTS 90054035ABBOTT PENTA SCS 3662 105000278 OTHER IMPLANTS 90054036ROD SOLERA 70MM COBALT 1161278 OTHER IMPLANTS 90054037KIT IZI BLAZER BONE CEMENT 12500278 OTHER IMPLANTS 90054038ROD OMNIA 5.5 X 30MM VALENCIA 500270 MED-SUR SUPPLIES 90054039ROD OMNIA 5.5 X 35MM VALENCIA 500270 MED-SUR SUPPLIES 90054041ROD OMNIA 5.5 X 45MM VALENCIA 500270 MED-SUR SUPPLIES 90054042ROD OMNIA 5.5 X 50MM VALENCIA 500278 OTHER IMPLANTS 90054043ROD OMNIA 5.5 X 55MM VALENCIA 750278 OTHER IMPLANTS 90054044ROD OMNIA 5.5 X 60MM VALENCIA 750278 OTHER IMPLANTS 90054045ROD OMNIA 5.5 X 65MM VALENCIA 750278 OTHER IMPLANTS 90054046ROD OMNIA 5.5 X 70MM VALENCIA 750270 MED-SUR SUPPLIES 90054047ROD OMNIA 5.5 X 75MM VALENCIA 750270 MED-SUR SUPPLIES 90054048ROD OMNIA 5.5 X 80MM VALENCIA 1000270 MED-SUR SUPPLIES 90054049ROD OMNIA 5.5 X 85MM VALENCIA 1000270 MED-SUR SUPPLIES 90054050ROD OMNIA 5.5 X 90MM VALENCIA 1000270 MED-SUR SUPPLIES 90054051ROD OMNIA 5.5 X 95MM VALENCIA 1000270 MED-SUR SUPPLIES 90054052ROD OMNIA 5.5 X 100MM VALENCIA 1000270 MED-SUR SUPPLIES 90054053ROD OMNIA 5.5 X 105MM VALENCIA 1470270 MED-SUR SUPPLIES 90054054ROD OMNIA 5.5 X 110MM VALENCIA 1470270 MED-SUR SUPPLIES 90054055ROD OMNIA 5.5 X 120MM VALENCIA 1470270 MED-SUR SUPPLIES 90054056BOXCAR END CAP 2.5 DEGREES 2129.25278 OTHER IMPLANTS 90054057PIRANHA DRILL BIT 12MM 796270 MED-SUR SUPPLIES 90054058DRILL BIT ACUTRAK2 MINI SHORT 1380272 STERILE SUPPLY 90054059SCR ACUMED ACUTRAK 2 16MM 2695278 OTHER IMPLANTS 90054060ABBOTT 3660 PT CONTROL SYSTEM 90000278 OTHER IMPLANTS 90054061ROD LEG 60MM 9690060 1161278 OTHER IMPLANTS 90054062BO NEVOS DBM FIBER PUTTY 10CC 5515278 OTHER IMPLANTS 90054063IM ULRICH CAG/VBR SM 12M 27100278 OTHER IMPLANTS 90054064PIN FIXATION OMNIA PRECISION ALIF 380278 OTHER IMPLANTS 90054065IM ULRICH CAG/VBR SM 12M 27100278 OTHER IMPLANTS 90054066SCR MED LAG CANNULATED 3 3170278 OTHER IMPLANTS 90054067SPINAL NEEDLE 8787 160272 STERILE SUPPLY 90054068ACELL MICROMATRIX 500MG 6932.5636 DRUGS/DETAIL CODE 90054069PL OMNIA VALENCIA CROSS LINK AL SZS 1800278 OTHER IMPLANTS 90054070KIT STRATUM 1ST MPJ INSTR 1744270 MED-SUR SUPPLIES 90054071PL IMPJ FUSION SM RT 8775278 OTHER IMPLANTS 90054072DRILL STRM CALIB 2.5MM ST 640270 MED-SUR SUPPLIES 90054073DRILL STRM CALIB 2.7MM ST 640270 MED-SUR SUPPLIES 90054074SCR STRM LOCKING 3.5 X 24MM 810278 OTHER IMPLANTS 90054075SCR STRM LOCKING 3.5 X 14MM 810278 OTHER IMPLANTS 90054076PL SM FRAG LOCKING HS 3280278 OTHER IMPLANTS 90054077PEG FULL THREAD 2.5 X 12MM 550278 OTHER IMPLANTS 90054078PEG FULL THREAD 2.5 X 14MM 550278 OTHER IMPLANTS 90054079PEG FULL THREAD 2.5 X 16MM 550278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90054080PEG FULL THREAD 2.5 X 18MM 550278 OTHER IMPLANTS 90054081PEG FULL THREAD 2.5 X 20MM 550278 OTHER IMPLANTS 90054082K-WIRE SS 1.6 X 127MM NS 180278 OTHER IMPLANTS 90054083DRILL BIT FAST 2.0MM 492270 MED-SUR SUPPLIES 90054084KIT NEX 3.5 MID 3.2 PROX STERILE 5616270 MED-SUR SUPPLIES 90054085SCR STRYKER HEADLESS 2.5X10 2477.2278 OTHER IMPLANTS 90054086GUIDE WIRE STRYKER 19 203.52272 STERILE SUPPLY 90054087PL SP/ ELE SAPPHIRE 3 LE 5300278 OTHER IMPLANTS 90054088ROD SP/EL O/WATCH 400 2940278 OTHER IMPLANTS 90054089BB ARM BANDS RED SLIM 3 4270 MED-SUR SUPPLIES 90054090SOLERA ROD MED 6.0 TITANIUM 1000278 OTHER IMPLANTS 90054092ROD OMNIA CORAL 600MM COCR 2940278 OTHER IMPLANTS 90054093NEVRO HF10-C KIT 1080-B 112250278 OTHER IMPLANTS 90054094KIT STRYKER IVAS ELITE 11G 10MM 4442270 MED-SUR SUPPLIES 90054095 NEEDLE AVAFLEX CURVED NEEDLE W/O CANNULA 1400 270 MED-SUR SUPPLIES 90054096BONE BIOPSY 11G IVAS 247.2278 OTHER IMPLANTS 90054097GOWN XX-LG KIM-CLARK SUBTITUTE 16.68272 STERILE SUPPLY 90054099 ROD DOMINO MRC 6.35 CLOSED/ 6.35 CLOSED 3825 278 OTHER IMPLANTS 90150092IV JELCO 22GAX1 JJ4050 4270 MED-SUR SUPPLIES 90150094IV NS 50ML 788436 15270 MED-SUR SUPPLIES 90150163IV D5W 50ML 710013 4270 MED-SUR SUPPLIES 90150169IV D5W.45% NS 20KCL 7902 7270 MED-SUR SUPPLIES 90150175IV NS .45% 1000ML 798509 12270 MED-SUR SUPPLIES 90150204IV NS 1000ML INJ A7983-0 12270 MED-SUR SUPPLIES 90150205IV NS 250ML 798302 12270 MED-SUR SUPPLIES 90150206IV NS 500ML 7983-03 / 2B 12270 MED-SUR SUPPLIES 90150207IV D5W 1000 ML 792209 4270 MED-SUR SUPPLIES 90150249MED ITREL 3/(IPG) 7425 33130278 OTHER IMPLANTS 90150266SCR TSRH TI 7.5 X 45 82 2194278 OTHER IMPLANTS 90150272SCR TSRH TI 6.5 X 55 82 2742278 OTHER IMPLANTS 90150398PHLEB WEDGE BLUE 408270 MED-SUR SUPPLIES 90150407SCR ARTHX BIO/TENODESIS 1425278 OTHER IMPLANTS 90150594SCREWS #8 5L497 (MAINT) 25278 OTHER IMPLANTS 90150595SCREWS #10 4P778 (MAINT) 32278 OTHER IMPLANTS 90150602LID MUG/BOWL 5 OZ MUG 8- 280270 MED-SUR SUPPLIES 90150612KIT LTA II PHARMACY 4698 14270 MED-SUR SUPPLIES 90150853BO SGT PROGENIX PLUS 1C 1185278 OTHER IMPLANTS 90150859SCR AES S4 ELEMENT ALL S 2763278 OTHER IMPLANTS 90150896MED SYNERGY IPG 7427 52255278 OTHER IMPLANTS 90150897MED SYNERGY EZ PROG 7435 4875278 OTHER IMPLANTS 90150912IV NORMOSOL R 7967-09/2B 12270 MED-SUR SUPPLIES 90150981K-WIRE ACUMED .045 WS-11 76278 OTHER IMPLANTS 90150988BO AES PROSPACE TLIF ALL 12500278 OTHER IMPLANTS 90151103IV PLASMA-LYTE R 2B253 33270 MED-SUR SUPPLIES 90151149SCR ACUMED LOC 2.7 AND 3 655278 OTHER IMPLANTS 90151313DRAPE SHEET 3 PLY 40X72 4270 MED-SUR SUPPLIES 90151321IM ZI/SPI TRINITY 1LV CE 6200278 OTHER IMPLANTS 90151346DRESSING COFLEX 2X5YD CO 6270 MED-SUR SUPPLIES 90151467SCR GLOBUS CITADEL VA AL 1275278 OTHER IMPLANTS 90151502SCREW 10.32 X .5 3278 OTHER IMPLANTS

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90151506SCREW 6.32 X .5 2.5278 OTHER IMPLANTS 90151571BO SGT ASR LASR CORNERST 2790278 OTHER IMPLANTS 90151604NERVE STIMULATOR FOR STI 1700270 MED-SUR SUPPLIES 90151683TRAY PICC LINE 4FR PERCU 240270 MED-SUR SUPPLIES 90152350BO INTEGRA OSTEOSPARX DB 5000278 OTHER IMPLANTS 90152378BO INTE/SP OSTEOSURGE 2 1125278 OTHER IMPLANTS 90152379SCR MED SAGITTAL ADJUST 6000278 OTHER IMPLANTS 90152418MED NEURO LEAD 3778-45 11710278 OTHER IMPLANTS 90152588IM ORTHO FIREBIRD 3 L LU 28000278 OTHER IMPLANTS 90152589IM ULRICH ADDPLUS CAGE C 35100278 OTHER IMPLANTS 90152590SCR ULRICH ADDPLUS OSMIU 1250278 OTHER IMPLANTS 90152591SCR ULRICH ADDPLUS SET S 300278 OTHER IMPLANTS 90152713PATIENT REMOTE BOS/ SCI 4000270 MED-SUR SUPPLIES 90152883LEAD MED EEG SUBCOMPACT 2500270 MED-SUR SUPPLIES 90152987KIT EZ-IO ACCESS PACK YE 160270 MED-SUR SUPPLIES 90153200IM GENSANO XPLUS MEMBRAN 5625278 OTHER IMPLANTS 90153249BO GENSANO MORSELIZED AL 11250278 OTHER IMPLANTS 90153250BO GENSANO CANCELLOUS CH 1750278 OTHER IMPLANTS 90153272SAVANNAH SCR OMNIA CANNULATED 4050278 OTHER IMPLANTS 90153334IM RTI STREAMLINE TL LUM 14000278 OTHER IMPLANTS 90153455SCR ASTURA OLYMPIC NON C 2775278 OTHER IMPLANTS 90153456PL MED CROSSLINK 8115516 2000278 OTHER IMPLANTS 90153459PL MED ZEVO CERV 29MM 30 3032278 OTHER IMPLANTS 90153460IM MED PRESTIGE LP ARTIF 22250278 OTHER IMPLANTS 90153461PL MED ZEVO CERV 67MM 30 3032278 OTHER IMPLANTS 90153462MED NEURO ITELLIS REPLAC 100000278 OTHER IMPLANTS 90153465IM AES ACTIV L SUP INF 22500278 OTHER IMPLANTS 90153466IM AES ACTIV L PE-INLAY 2500278 OTHER IMPLANTS 90153467MARKER AES MIDLINE ACTIVE L 320270 MED-SUR SUPPLIES 90153469DRILL BIT VERTEX SELECT 864270 MED-SUR SUPPLIES 90153470PL MED OCCIPITAL SMALL K 11825278 OTHER IMPLANTS 90153471ROD MED OCCIPITAL CHROMA 2358278 OTHER IMPLANTS 90153472CONNECTOR MED MAS EXTENS 2041270 MED-SUR SUPPLIES 90153473SCR MED MAS SET LOCKING 500278 OTHER IMPLANTS 90153474SCR MED MAS CROSSLINK SE 500278 OTHER IMPLANTS 90153475BO ORG 2CC CRUSHED CANCE 475278 OTHER IMPLANTS 90153476SU S/N TWINFIX ULTRA ANC 1225278 OTHER IMPLANTS 90153477SCR MED CANNULATED BALLA 6000278 OTHER IMPLANTS 90153478PL MED OFFSET CONNECTOR 2000278 OTHER IMPLANTS 90153486PATIENT OVERNIGHT COMFOR 33270 MED-SUR SUPPLIES 90153617IM ONE SURG LUM 1 LVL CON 12600278 OTHER IMPLANTS 90153618ROD MED MRC 5.5 OPEN 6.3 4250278 OTHER IMPLANTS 90153619BO ALPHATECH CERVICAL SP 2790278 OTHER IMPLANTS 90153744MED NEURO PADDLE 90CM 97 30380278 OTHER IMPLANTS 90153786SCR SPINAL ELE OVERWATCH 4050278 OTHER IMPLANTS 90153787NEVRO SURGICAL LEAD 50CM 12500278 OTHER IMPLANTS 90153788SCR MED CANNULATED BALLAST 6000278 OTHER IMPLANTS 90153789CONNECTOR OP/CL ENNOVATE 2000278 OTHER IMPLANTS 90153819IV CATH INSYTE 20G X 1.1 340270 MED-SUR SUPPLIES 90153820IV CATH INSYTE 18G X 1.1 340270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020 Oklahoma Spine Hospital

90153821IV CATH 22G X 1IN 382523 340270 MED-SUR SUPPLIES 90153872SCR MED SOLERA DUAL ROD 7500278 OTHER IMPLANTS 90153880PROBE NERVE MINISTIM MS- 287270 MED-SUR SUPPLIES 90153956ISTAT ELECTRONIC STIMULATOR 163270 MED-SUR SUPPLIES 90153957CUFF BP ADULT LONG DATA RE-US 100270 MED-SUR SUPPLIES 90153958MASK LMA SIZE 4 PATIENT 100270 MED-SUR SUPPLIES 90153960OXISENSOR FOREHEAD 43270 MED-SUR SUPPLIES 90154000CUFF BP LG LNG ADLT DATA RE-US 100270 MED-SUR SUPPLIES 90154001INFINITY ROD MED POST CERVICAL 900278 OTHER IMPLANTS 90154008CANNULA HF ADULT GRN 4270 MED-SUR SUPPLIES 90154011MASK LMA SZ.3 105200-000030 400272 STERILE SUPPLY 90154012PURAPLY AM 5X5 13750636 DRUGS/DETAIL CODE 90154013 CABLE SPO2 FOR PASSPORT 12 115-020768-00 829 270 MED-SUR SUPPLIES 90154016 VALENCIA IM OMNIA LUMBAR 4 LEVEL CONST 31500 278 OTHER IMPLANTS 90154019PIPETTE FIXED VOLUME MLA 1ML GRAY 352270 MED-SUR SUPPLIES 90154020OCCIPITAL PREBENT ROD 3600201 2500278 OTHER IMPLANTS 90154021OCCIPITAL SCR 4.5 X 6MM 2925278 OTHER IMPLANTS 90154022OCCIPITAL SCR 4.5 X 8MM 2925278 OTHER IMPLANTS 90154023OCCIPITAL SCR 4.5 X 10MM 2925278 OTHER IMPLANTS 90154025STENT BOSTON SCIENTIFIC 452.15270 MED-SUR SUPPLIES 90154027BILE BAG STERILE 19OZ 22.64272 STERILE SUPPLY 90154028OXISENSOR ADULT NOSE MAX-R 43270 MED-SUR SUPPLIES 90454019IM ULRICH OBELISC VBR CE 35000278 OTHER IMPLANTS 90454020IM ULRICH OBELISC END PIECE 11000278 OTHER IMPLANTS 90454021BO STRYKER BIO DBM 5CC 2755278 OTHER IMPLANTS 90454022INFINITY ROD MED POST CERVICAL 30MM 810278 OTHER IMPLANTS 90454025HAEMONETICS VACUUM LINE HAR-A-1000 60272 STERILE SUPPLY 90454026 KIT ZAVATION 10g/15mm BIPEDICULAR VCF-1 8600 270 MED-SUR SUPPLIES

Charge Master as of June 3, 2020