The Anthem Blue Cross and Blue Shield Ohio 2015 Pathway X Tiered Network include the following Hospitals, ASC Facilities and Large PCP Groups: HOSPITAL COUNTY TIER Adams County Regional Medical Center Adams Tier 1 Bluffton Hospital Allen Tier 1 Lima Memorial Hospital Allen Tier 1 Samaritan Regional Health System Ashland Tier 1 Ashtabula County Medical Center Ashtabula Tier 1 University Hospitals — Conneaut Medical Center Ashtabula Tier 1 University Hospitals — Geneva Medical Center Ashtabula Tier 1 Belmont Community Hospital Belmont Tier 1 East Ohio Regional Hospital (a.k.a., Ohio Valley Medical Center) Belmont Tier 1 Bethesda Butler Hospital Butler Tier 1 Fort Hamilton Hughes Hospital Butler Tier 1 Ohio Valley Medical Center* Clark Tier 1 Clinton Memorial Hospital Clinton Tier 1 East Liverpool City Hospital Columbiana Tier 1 Salem Comm Hospital Columbiana Tier 1 Coshocton County Memorial Hospital Coshocton Tier 1 Bucyrus Community Hospital Crawford Tier 1 Galion Community Hospital Crawford Tier 1 Metrohealth System Medical Center Cuyahoga Tier 1 Parma Comm General Hospital Cuyahoga Tier 1 Southwest General Health Center Cuyahoga Tier 1 St. John Medical Center Cuyahoga Tier 1 St. Vincent Charity Hospital Cuyahoga Tier 1 University Hospitals — Ahuja Medical Center Cuyahoga Tier 1 University Hospitals — Bedford Medical Center Cuyahoga Tier 1 University Hospitals — Case Medical Center Cuyahoga Tier 1 University Hospitals — MacDonald Women's Hospital Cuyahoga Tier 1 University Hospitals — Rainbow Babies and Children's Hospital Cuyahoga Tier 1 University Hospitals — Richmond Medical Center Cuyahoga Tier 1 University Hospitals — Seidman Cancer Center Cuyahoga Tier 1 ProMedica Defiance Regional Hospital Defiance Tier 1 Firelands Regional Medical Center Erie Tier 1 Fairfield Medical Center Fairfield Tier 1 Fayette County Memorial Hospital Fayette Tier 1 Diley Ridge Medical Center Franklin Tier 1 Mount Carmel East Franklin Tier 1 Mount Carmel New Albany Surgical Hospital Franklin Tier 1 Mount Carmel West Franklin Tier 1 Anthem Blue Cross and Blue Shield is the trade name of Community Insurance Company. Independent licensee of the Blue Cross and Blue Shield Association. ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. 43323OHMENABS Rev. 08/14 1 of 8 HOSPITAL COUNTY TIER Nationwide Children’s Hospital Franklin Tier 1 St. Ann's Hospital Franklin Tier 1 Community Hospitals and Wellness Centers — Archbold Medical Fulton Tier 1 Center Holzer Medical Center Gallia Tier 1 University Hospitals — Geauga Medical Center Geauga Tier 1 Beavercreek (Soin) Medical Center Greene Tier 1 Greene Memorial Hospital Greene Tier 1 Southeastern Ohio Regional Medical Center (SEORMC) Guernsey Tier 1 Bethesda Hospital Hamilton Tier 1 Christ Hospital Hamilton Tier 1 Cincinnati Children’s Hospital Medical Center Hamilton Tier 1 Good Samaritan Hospital Hamilton Tier 1 TriHealth Evendale Hospital Hamilton Tier 1 Blanchard Valley Hospital Hancock Tier 1 Henry County Hospital Inc Henry Tier 1 Adena Greenfield Medical Center Highland Tier 1 Highland District Hospital Highland Tier 1 Holzer Medical Center Jackson Jackson Tier 1 Trinity Health System Jefferson Tier 1 Lake West Hospital Lake Tier 1 Tripoint Medical Center Lake Tier 1 EMH Regional Medical Center Lorain Tier 1 ProMedica Bay Park Hospital Lucas Tier 1 ProMedica Flower Hospital Lucas Tier 1 ProMedica St. Luke's Hospital Lucas Tier 1 ProMedica Toledo Children’s Hospital Lucas Tier 1 ProMedica Toledo Hospital Lucas Tier 1 Northside Medical Center Mahoning Tier 1 St. Elizabeth Boardman Health Center Mahoning Tier 1 St. Elizabeth Health Center Mahoning Tier 1 Surgical Hospital at Southwoods Mahoning Tier 1 Lodi Community Hospital Medina Tier 1 Dayton Children's Hospital Montgomery Tier 1 Grandview Medical Center Montgomery Tier 1 Kettering Medical Center Montgomery Tier 1 Southview Medical Center Montgomery Tier 1 Sycamore Medical Center (Kettering) Montgomery Tier 1 Genesis Healthcare Systems Muskingum Tier 2 2 of 8 HOSPITAL COUNTY TIER Paulding County Hospital Paulding Tier 1 Adena Pike Medical Center Pike Tier 1 Robinson Memorial Hospital Portage Tier 1 Adena Regional Medical Center Ross Tier 1 Bellevue Hospital Sandusky Tier 1 Memorial Hospital Sandusky Tier 1 Kings Daughters Medical Center Scioto Tier 1 Southern Ohio Medical Center (SOMC) Scioto Tier 1 ProMedica Fostoria Community Hospital Seneca Tier 1 Wilson Memorial Hospital Shelby Tier 1 Affinity Medical Center — Doctors Campus Stark Tier 1 Alliance Community Hospital Stark Tier 1 Mercy Medical Center Canton Stark Tier 1 Akron General Medical Center Summit Tier 1 Edwin Shaw Rehab Summit Tier 1 Western Reserve Hospital Summit Tier 1 Hillside Rehab Hospital Trumbull Tier 1 St. Joseph Health Center Trumbull Tier 1 Trumbull Memorial Hospital Trumbull Tier 1 Trinity Hospital Twin City Tuscarawas Tuscarawas Tier 1 Van Wert County Hospital Van Wert Tier 1 Marietta Memorial Hospital Washington Tier 1 Selby General Hospital Washington Tier 1 Wooster Community Hospital Wayne Tier 1 Community Hospitals and Wellness Centers — Bryan Hospitals Williams Tier 1 Community Hospitals and Wellness Centers — Montpelier Williams Tier 1 Hospital 3 of 8 AMBULATORY SURGERY CENTER (ASC) FACILITY COUNTY TIER An ASC is a facility where outpatient surgeries and procedures are performed. The patient is treated and released the same day. Digestive Health Complex Belmont Tier 1 Valley Endoscopy Center Belmont Tier 1 SW Ohio Ambulatory Surg Butler Tier 1 The GI Endoscopy Center Butler Tier 1 Clinton County Outpatient Surgery Center Clinton Tier 1 Wilmington Surgical Services Clinton Tier 1 Big Creek Surgery Center Cuyahoga Tier 1 Legacy Surgery Center Cuyahoga Tier 1 North Ohio Endoscopy Center Cuyahoga Tier 1 North Shore Endoscopy Center Cuyahoga Tier 1 Planned Parenthood of Greater Cleveland Cuyahoga Tier 1 Premier Physicians Ambulatory Surgery Center Cuyahoga Tier 1 The Center of GI Endoscopy Cuyahoga Tier 1 The Surgery Center Cuyahoga Tier 1 The Surgery Center Pearl Cuyahoga Tier 1 University Hospitals Lyndhurst Surgery Center Cuyahoga Tier 1 University Hospitals Westlake Surgery Center Cuyahoga Tier 1 University Suburban Endoscopy Center Cuyahoga Tier 1 NovaMed Surgery Center of Sandusky Erie Tier 1 Affiliated Ambulatory Surgery Center LLC Franklin Tier 1 Planned Parenthood East Columbus Surgical Center Franklin Tier 1 Eastwind Surgical Center Franklin Tier 1 New Albany Surgery Center Franklin Tier 1 Taylor Station Surgery Center Franklin Tier 1 The Eye Center of Columbus Franklin Tier 1 Chardon Surgery Center Geauga Tier 1 Endoscopy Center at Bainbridge Geauga Tier 1 Dayton Eye Surgery Center Greene Tier 1 Dayton Eye Surgery Center Greene Tier 1 Beacon Orthopaedics Surgical Center LLC Hamilton Tier 1 Cincinnati Eye Institute Hamilton Tier 1 Norwood Endoscopy Center Hamilton Tier 1 Planned Parenthood of Southwest Ohio Hamilton Tier 1 The Christ Hospital Spine Surgery Center Hamilton Tier 1 The Urology Center Hamilton Tier 1 Tri State Endoscopy Hamilton Tier 1 Tri State Eye Surgery Center Hamilton Tier 1 University Endoscopy Center Hamilton Tier 1 4 of 8 ASC FACILITY COUNTY TIER Findlay Surgery Center Hancock Tier 1 Valley Surgery Center Jefferson Tier 1 CDH Endoscopy Center Lake Tier 1 Mentor Surgery Center Lake Tier 1 The Endoscopy Center of Lake County Lake Tier 1 University Hospitals Mentor Surgery Center Lake Tier 1 Premium Surgery Center LLC Lorain Tier 1 Artisan Surgery Center Lucas Tier 1 Northwest Ohio Endoscopy Center Lucas Tier 1 Surgicare Ambulatory Surgery Center Lucas Tier 1 Belmont Eye Surgery Mahoning Tier 1 Center for Advanced Eye Surgery Mahoning Tier 1 Lee Surgery Center Mahoning Tier 1 Mill Creek Endoscopy Suites Mahoning Tier 1 Orthopaedic Surgery Center Mahoning Tier 1 Surgery Center of Canfield LLC Mahoning Tier 1 Digestive Care Inc Montgomery Tier 1 Endoscopy Center Of Dayton North Montgomery Tier 1 Governors Place ASC LLC Montgomery Tier 1 Physicians Ambulatory Surgery Center Pickaway Tier 1 Western Reserve Surgery Center Portage Tier 1 Revision Advanced Surgery Center Inc Richland Tier 1 CG Endoscopy Center Stark Tier 1 Eyes on Stark/Vista Surgery Center Stark Tier 1 Gastroenterology Aso Stark Tier 1 Gastroenterology Spec Stark Tier 1 Global Ambulatory Surgical Center Stark Tier 1 Stark Ambulatory Surgery Center Stark Tier 1 Center for Surgery Summit Tier 1 Digestive Health Center Ltd Summit Tier 1 St Clare Surgery Center Summit Tier 1 Surgery Center at Akron General Health and Wellness Summit Tier 1 System Optics (Novus Clinic) Summit Tier 1 Avamar Center for Endoscopy Trumbull Tier 1 Lippy Surgery Center Trumbull Tier 1 Warren Gastrointestinal Endoscopy Center Trumbull Tier 1 Tuscarawas Amb Surgery Center Tuscarawas Tier 1 Marietta Surgery Center Washington Tier 1 Ohio Valley Ambulatory Surgery Center Washington Tier 1 The Eye Surg Center Wooster Wayne Tier 1 Wooster ASC Wayne Tier 1 Lima Memorial Professional Corporation Allen Tier 1 5 of 8 LARGER PRIMARY CARE PHYSICIAN GROUPS COUNTY TIER Ashtabula County Medical Center Group Ashtabula Tier 1 University Hospital Medical Group Ashtabula Tier 1 University Hospital Primary Care Practices Ashtabula Tier 1 Group Health — TriHealth Butler Tier 1 Kettering Alliance Butler Tier 1 Queen City Physicians — TriHealth Butler Tier 1 TriHealth Physician Practices LLC Butler Tier 1 Family Physicians of Springfield Clark Tier 1 Providence Medical Group: Medway Medical Clinic Clark