All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 1 of 24

POLICY TITLE: Centura Health Financial Assistance Policy DEPARTMENT: Revenue Management ORIGINATION DATE: 11/01/2006 CATEGORY: Billing EFFECTIVE DATE: July 1, 2016

ADDENDUM C

NON-COVERED PROVIDERS (Revised 1/2/2018)

*Provider list to be updated quarterly.

The following professional charges are not covered by the Centura FAP. Inquiries should be made by the patient with these organizations directly as they may have their own financial assistance policies.

1ST CHOICE SURGICAL SERVICES 4319 CONSULTING LLC 5280 ANESTHESIA 5280 PEDIATRIC DENTISTRY AARON SMITH PLASTIC SURGERY ACADEMY PARK PEDIATRICS ACADEMY WOMEN'S HEALTHCARE ASSOCIATES ACCORD SURGICAL ASSISTING, LLC ADVANCED ANESTHESIA ASSOCIATES ADVANCED BRAIN AND SPINE, LLC ADVANCED CARE OPTIONS ADVANCED EAR, NOSE & THROAT, INC. ADVANCED GYNECOLOGY & INFERTILITY, PC ADVANCED ORTHOPEDIC AND SPORTS MEDICINE SPECIALISTS, PC ADVANCED PEDIATRICS ADVANCED SPINE & SPORTS SPECIALISTS, LLC ADVANCED UROLOGY, PC ADVANCED WOMEN'S HEALTH INSTITUTE ADVANTAGE ENT, LLP AFFILIATES IN ORAL & MAXILLOFACIAL SURGERY ALAN F STAGE MD, A PLLC ALAN REISMAN, DDS ALBRECHT WOMEN'S CARE DENVER IVF ALFRED NATHAN CARR, MD

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 2 of 24

ALL ABOUT WOMENS CARE ALL STAR RECRUITING ALLAN J COLTRAIN, CST, CSFA ALLERGY & ASTHMA CENTER ALLERGY & ASTHMA SPECIALISTS ALLERGY ASTHMA AND SINUS CENTER LLC ALPENGLOW GYNECOLOGY AND MEDICAL SPA, LLC ALPINE EYE CLINIC ALPINE SURGICAL LLC ALPINE UROLOGY PC ALPINE VALLEY ORAL SURGERY ALTA VISTA DERMATOLOGY AMERICAN SURGICAL PROFESSIONALS AMERICAN VEIN AND VASCULAR INSTITUTE ANANT KUMAR, MD ANESTHESIA CONSULTANTS ANIMAS FOOT AND ANKLE PC ANIMAS PLASTIC SURGERY, PC ANNETTE RILEY FLANNERY, RN, CSFA APEX EMERGENCY GROUP, PC ARAPAHOE DOUGLAS MENTAL HEALTH NETWORK - PRINCE ST ARAPAHOE PARK PEDIATRICS ARAPAHOE PROFESSIONAL SURGICAL ASSISTANTS ARBOR FAMILY MEDICINE ARLIN RAY PETERSON, DPM ASARCH CENTER FOR DERMATOLOGY, LASER & MOHS SURGERY ASHAKIRAN JAYASIMHA SUNKU, MD ASSOCIATES IN EYE CARE, PC ASSOCIATES IN GASTROENTEROLOGY, PC ASSOCIATES IN MAXILLOFACIAL & ORAL SURGERY, PC ASSOCIATES IN WOMEN'S CARE, PC ASSOCIATES IN WOMEN'S HEALTH CARE ASSOCIATES OF OTOLARYNGOLOGY

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 3 of 24

ASSURE NEUROMONITORING, LLC AURORA PLASTIC SURGERY, PC AURORA-DENVER CARDIOLOGY ASSOCIATES, PC AUTOBEE DENTAL CENTER AXIS HEALTH SYSTEMS BANNER HEALTH CLINIC ANESTHESIA BARIATRIC AND AESTHETIC SURGERY ASSOCIATES BARIATRIC SPA BELLA NATURAL WOMEN'S CARE BERND GEORG LAUBER, MD BETH ROLAND, M.D., PC BETTY ANN PETRAK-RON, MD BISHOP/PETERSON, MD, PC BLUE SKY NEUROLOGY A DIVISION OF CAREPOINT PC BOULDER BONE AND JOINT BOULDER EYE SURGEONS BOULDER MEDICAL CENTER BOULDER NEUROSURGICAL & SPINE ASSOCIATES BOULDER NEUROSURGICAL & SPINE ASSOCIATES, PLLC BOULDER PAIN INSTITUTE, PC BOULDER PLASTIC SURGERY PROF LLC BOULDER VALLEY EAR, NOSE & THROAT ASSOCIATES BOULDER VALLEY NEUROLOGY BOULDER VALLEY PLASTIC SURGERY BOULDER VALLEY PULMONOLOGY BOULDERCENTRE FOR ORTHOPEDICS BRADLEY WILLIAM RENEHAN, DDS, MD BRAY SURGICAL ASSISTING BRENT JERALD SMITH, MD BRIAN ERNEST HENRY REISS, MD BRIAN WILLOUGHBY, MD, PC BRIARGATE PEDIATRIC DENTISTRY PC BRIGHT NOW DENTAL

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 4 of 24

BROADWAY PLASTIC SURGERY BROOMFIELD FAMILY PRACTICE BROOMFIELD PEDIATRICS BUCKLEY VISION INSTITUTE BURN AND RECONSTRUCTIVE CENTERS OF COLORADO BUTTON FAMILY PRACTICE CANON FAMILY MEDICINE CARE PLUS SYSTEMS, INC. CAREPOINT, PC CAROL A. GOLDBERG, MD CASTLE ROCK FOOT AND ANKLE CARE CASTLE ROCK KIDS DENTISTRY CASTLE ROCK ORAL & MAXILLOFACIAL SURGERY CASTLE ROCK PEDIATRICS CASTLE ROCK SMILES PEDIATRIC DENTISTRY CENTENNIAL FOOT CARE CENTENNIAL PEDIATRICS PC CENTENNIAL RADIATION ONCOLOGY PC CENTENNIAL VALLEY PEDIATRICS CENTENNIAL WOMEN'S HEALTH CENTER CENTER FOR COSMETIC SURGERY CENTER FOR CRANIOFACIAL & FACIAL PLASTIC SURGERY CENTER FOR HEADACHES & TMJ & SLEEP DISORDERS CENTER FOR PLASTIC & AESTHETIC SURGERY CENTER FOR PLASTIC SURGERY AT CASTLE ROCK INC CENTER FOR SPINE & ORTHOPEDICS, PC CENTER FOR WOMEN'S HEALTH CENTER OF SURGICAL SPECIALISTS, PC CHERRY CREEK EYE PHYSICIANS & SURGEONS, PC CHERRY CREEK ORAL AND MAXILLOFACIAL SURGERY, PC CHEYENNE FOOT & ANKLE, INC. CHILDREN'S CLINIC CHILDREN'S EYE CENTER, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 5 of 24

CHILDREN'S EYE PHYSICIANS CHILDREN'S HOSPITAL COLORADO CHILDREN'S HOSPITAL COLORADO - EMERGENCY DEPARTMENT CHILDREN'S HOSPITAL COLORADO - NEONATOLOGY CHILDREN'S HOSPITAL COLORADO - PEDIATRIC HOSPITAL MEDICINE CHIPS CHILDREN'S INPATIENT PHYSICIAN SERVICES CHMG - CARBON VALLEY MEDICAL CENTER CHOICES IN HEALTH CHRIS ALLEN CARLISLE, CST/CFA CHRISTOPHER DALE GEIGER, CST/CSFA CHRISTOPHER GERARD VIALPANDO, MD CHRISTOPHER YOU CHEE LOUIE, MD CK SURGICAL, LLC CLEAR CREEK MEDICAL GROUP CLINICA FAMILY HEALTH SERVICES CLINTON CALLAHAN, DMD, PC CNS MEDICAL GROUP, PC COAL CREEK FAMILY MEDICINE COAL CREEK ORAL SURGERY AND DENTAL IMPLANT CENTER, PLLC COAL CREEK PLASTIC & COSMETIC SURGERY COLORADO ALLERGY & ASTHMA CENTERS PC COLORADO BLOOD AND CANCER CARE COLORADO BRAIN & SPINE INSTITUTE, LLC COLORADO CARDIOVASCULAR SURGICAL ASSOCIATES PC COLORADO CENTER FOR ARTHRITIS AND OSTEOPOROSIS LLC COLORADO CENTER FOR DIGESTIVE DISORDERS COLORADO CENTER FOR GYNECOLOGIC ONCOLOGY COLORADO CENTER FOR NEUROSCIENCE COLORADO CENTER FOR REPRODUCTIVE MEDICINE COLORADO CENTER OF ORTHOPAEDIC EXCELLENCE COLORADO CHILDRENS MEDICAL GROUP COLORADO CLINICS FOR THE FOOT AND ANKLE COLORADO COLON & RECTAL SPECIALISTS

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 6 of 24

COLORADO COMPREHENSIVE SPINE INSTITUTE, LLC COLORADO DERMATOLOGY CENTER COLORADO DERMATOLOGY INSTITUTE COLORADO EAR, NOSE, & THROAT COLORADO ENT AND ALLERGY COLORADO EYE INSTITUTE COLORADO FACIAL PLASTIC SURGERY CENTER COLORADO FOOT AND ANKLE COLORADO FOOT AND ANKLE CLINIC, PC COLORADO FOOT AND ANKLE SPORTS MEDICINE, LLC COLORADO HAND CENTER COLORADO HEALTH PROVIDERS COLORADO HEARING & BALANCE CLINIC COLORADO HEART AND VASCULAR PC COLORADO HEART CLINIC COLORADO HOSPITALIST COMPANY COLORADO IMAGING ASSOCIATES, PC COLORADO INFECTIOUS DISEASE ASSOCIATES COLORADO INSTITUTE OF COLON & RECTAL SURGERY COLORADO KIDNEY CARE PC COLORADO LIMB CONSULTANTS COLORADO NEURODIAGNOSTICS COLORADO OPHTHALMOLOGY ASSOCIATES COLORADO ORAL SURGERY COLORADO ORTHOPAEDICS COLORADO ORTHOPEDIC CONSULTANTS, PC COLORADO PAIN COLORADO PAIN CONSULTANTS COLORADO PAIN MANAGEMENT & ANESTHESIA CONSULTANTS COLORADO PHYSICIANS SURGICAL ASSISTANTS, INC COLORADO PLASTIC SURGERY CENTER COLORADO PODIATRY CONSULTANTS PC COLORADO PULMONARY ASSOCIATES

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 7 of 24

COLORADO PULMONARY INTENSIVISTS COLORADO REHABILITATION AND OCCUPATIONAL MEDICINE COLORADO REHABILITATION PHYSICIANS COLORADO RETINA ASSOCIATES, PC COLORADO SLEEP INSTITUTE-BROOMFIELD COLORADO SPRINGS DERMATOLOGY CLINIC, PC COLORADO SPRINGS EAR ASSOCIATES COLORADO SPRINGS EYE CLINIC COLORADO SPRINGS FOOT & ANKLE CLINIC COLORADO SPRINGS HEALTH PARTNERS - BRIARGATE COLORADO SPRINGS HEALTH PARTNERS - CENTRAL COLORADO SPRINGS HEALTH PARTNERS, PC COLORADO SPRINGS INTERVENTIONAL PAIN MANAGMENT PC COLORADO SPRINGS NEPHROLOGY COLORADO SPRINGS NEUROLOGICAL ASSOCIATES COLORADO SPRINGS ORAL SURGERY COLORADO SPRINGS ORTHOPAEDIC GROUP COLORADO SPRINGS ORTHOPAEDIC GROUP - AUDUBON COLORADO SPRINGS PEDIATRIC DENTISTRY COLORADO SPRINGS PULMONARY CONSULTANTS, PC COLORADO SPRINGS RADIOLOGISTS, PC COLORADO SPRINGS SURGICAL ASSOCIATES, PC COLORADO SURGICAL & ANESTHESIA SERVICES, PC COLORADO SURGICAL AND CRITICAL CARE ASSOCIATES COLORADO SURGICAL SERVICE PC COLORADO VOICE CLINIC, PC COLUMBINE FOOT & ANKLE CENTER COMFORT DENTAL ORAL SURGERY COMMUNITY ANESTHESIA CONSULTANTS LLC COMMUNITY FOOT & ANKLE CLINIC COMPASS MENTAL HEALTH SERVICES COMPREHENSIVE ENT, PC CONCEPTIONS REPRODUCTIVE ASSOCIATES OF COLORADO

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 8 of 24

CONRAD J TIRRE, MD CONSULTANTS IN NEPHROLOGY AND HYPERTENSION CORNEAL CONSULTANTS OF COLORADO, PC CORNERSTONE ORTHOPEDICS & SPORTS MEDICINE PC CORNERSTONE PEDIATRIC ASSOCIATES, INC CORWIN CLINIC SURGICAL, PC CRAIG ANTHONY REYNOLDS, MD CRAIG HORNBARGER, MD F.A.C.S CRITICAL CARE AND PULMONARY CONSULTANTS, PC CRITICAL CARE, PULMONARY AND SLEEP ASSOCIATES PLLP CRNA ASSOCIATES, INC CROWLEY COUNTY CORRECTIONAL FACILITY CUTARELLI VISION CUTTING EDGE SURGICAL, INC. DANIEL ELLIOTT STILWELL, DPM DANIEL J MACFARLANE, DPM DANIEL JAMES FLORES, CST CSA DANIEL PAUL MALLETT, DPM DAVID ALAN JONES, MD DEBORA MA, MD PC DELTA LOCUM TENENS DENTAL ARTS OF CHERRY HILLS DENVER BACK PAIN SPECIALISTS, LLC DENVER EAR ASSOCIATES DENVER FOOT & ANKLE CLINIC DENVER HEALTH MEDICAL CENTER DENVER INTERNATIONAL SPINE CENTER DENVER METRO ORTHOPAEDICS PC DENVER NEURODIAGNOSTICS, LLC DENVER NEUROLOGICAL CLINIC DENVER ONCOLOGY, PC DENVER SPINE CENTER DENVER UROLOGY CLINIC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 9 of 24

DENVER-VAIL ORTHOPEDICS, PC DERMATOLOGY ASSOCIATES OF COLORADO DEXTER DONALD KOONS, MD DIANE ELIZABETH GIUSTI, PA-C DIEHL ANESTHESIA DIGESTIVE DISEASE SPECIALISTS OF COLORADO DIGESTIVE HEALTH ASSOCIATES, PC DISPATCHHEALTH DIVERSIFIED RADIOLOGY OF COLORADO DOCTORS MEDICAL GROUP OF COLORADO SPRINGS DR. KIM K. DERNOVSEK DRS. DAY & RUBY DRS. DOUGHERTY & ROBERTS DRS. MANN & PULS DRS. RENDLER & ARGUELLO DRY CREEK SURGERY PC DTC EYE ASSOCIATES, PC DURANGO DERMATOLOGY DURANGO NEUROLOGICAL ASSOCIATES, PC EA SMITH, PAC, INC EAGLE-SUMMIT FOOT & ANKLE, PC EAR, NOSE AND THROAT OF PARKER EBERT FAMILY CLINIC ECHO LOCUM TENENS, INC EDWARD JAMES HO, MD EDWARD K RACZKA, DPM, PC EITAN MEDINA, MD, PC ELDORADO RETINA ASSOCIATES PC ELEVATED ORAL AND MAXILLOFACIAL SURGERY ELITE NEUROMONITORING, LLC ELITE OCULOPLASTIC SURGERY, PC ELMER A VILLALON, DMD ENDOCRINE SERVICES, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 10 of 24

ENT CLINIC OF PUEBLO, PC ERIC K. HAMMERBERG MD, PC ERICKSON PEDIATRIC DENTISTRY & ORTHODONTICS ERIK H RIEGER, MD, PC ESPRIT WOMAN CARE EVANS ARMY COMMUNITY HOSPITAL (FORT CARSON) EXCELLENCE IN ORAL & MAXILLOFACIAL SURGERY EXCEPTIONAL CARE FOR WOMEN, PLLC EXEMPLA GOOD SAMARITAN HOSPITAL EXEMPLA ST JOSEPH HOSPITAL EYE ASSOCIATES OF COLORADO SPRINGS, PC EYE CARE CENTER OF NORTHERN COLORADO EYE SPECIALISTS OF COLORADO FAMILY HEALTH CARE CENTER FLATIRON INTERNAL MEDICINE FLATIRONS FOOT AND ANKLE CLINIC PC FLATIRONS OPHTHALMOLOGY FLATIRONS SURGICAL ASSISTING, INC. FOCUS ON KIDS FOOT & ANKLE CENTER OF NORTHERN COLORADO PC FOOT AND ANKLE INSTITUTE OF COLORADO FOOT SPECIALIST ASSOCIATES, PC FOOTHILLS ANESTHESIA, LLC FOOTHILLS UROGYNECOLOGY, PC FOOTHILLS UROLOGY FOUR CORNERS FOOT AND ANKLE PC FOUR CORNERS OB/GYN FOUR CORNERS ORAL & MAXILLOFACIAL SURGERY FOUR CORNERS SMILES 4 KIDS, INC. FRANCESCO EMILIO CAMPANILE, MD FRANKLIN SZU-CHIEN CHOW, MD FREELANCE ASSISTANTS FREMONT FOOT AND ANKLE

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 11 of 24

FRONT RANGE CENTER FOR SPINE & SPORTS MEDICINE FRONT RANGE EMERGENCY SPECIALISTS PC FRONT RANGE EYE PHYSICIANS FRONT RANGE EYE PHYSICIANS & SURGEONS FRONT RANGE KIDNEY CARE FRONT RANGE OBSTETRICS & GYNECOLOGY, PC FRONT RANGE ORTHOPEDICS & SPINE FRONT RANGE OTOLARYNGOLOGY & FACIAL PLASTIC SURGERY PC FRONT RANGE SPINE AND NEUROSURGERY FRONT RANGE SURGICAL ASSOCIATES, PC FRONT RANGE SURGICAL SERVICES, PC FRONTIER NEUROLOGY AND NEUROMUSCULAR CLINIC GARDEN SURGICAL ASSOCIATES GARY R. SNIDER, MD GENITOURINARY SURGICAL CONSULTANTS GEOFFREY S KIM, MD GEORGE V. ROSSIE, PHD & ASSOCIATES GOLDSTAR SURGICAL ASSISTING GORDON PAUL RHEAUME, DPM GORMAN MEDICAL LLC GREENWOOD EAR, NOSE & THROAT SPECIALISTS, PC GREENWOOD PEDIATRICS, PC GREGORY FRANKLIN BLAND, MD GREGORY J LIEBSCHER, MD GROSSMAN PLASTIC SURGERY GUARDIAN ANESTHESIA SERVICES INC HAAS VISION CENTER HAI PHONG BUI, MD HAND SURGERY ASSOCIATES, PC HANSON CLINIC PC HAPPY FEET PODIATRY HEALOGICS HEALTHSOUTH REHABILITATION HOSPITAL

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 12 of 24

HEARTLAND CANCER-ONCOLOGY HEIDI J OSTER MD, PC HELENE G DESMARAIS, PA-C HEOLOGICS HERITAGE INTERNAL MEDICINE, PC HERMAN RANDOLPH FRANK, MD HERMAN V ARISTOV, CSFA HIGH COUNTRY SURGICAL ASSISTING, INC. HIGH PLAINS ANESTHESIA CONSULTANTS, PC HIGH PLAINS HEART & VASCULAR CENTER, LLC HIGH PLAINS UROLOGY HIGHLANDS BEHAVIORAL HEALTH SYSTEMS HINES-SIGHT HOPE INTERNAL MEDICINE OF PUEBLO, LLC HORIZONS FOOT & ANKLE CLINIC HOWARD GROSSBARD, MD IMMUNOE HEALTH CENTERS IMPLANT AND ORAL SURGERY CENTER INCLINE ORTHOPAEDICS INFECTIOUS DISEASE SPECIALISTS, PC INPATIENT CONSULTANTS OF COLORADO INSIGHT RETINA CONSULTANTS, PC INSTITUTE OF AESTHETIC PLASTIC & RECONSTRUCTIVE SURGERY, LLC INTERMOUNTAIN FOOT AND ANKLE INTERNAL MEDICINE ASSOCIATES OF COLORADO SPRINGS INTERNAL MEDICINE SOUTHWEST, PC INTERWEST REHABILITATION, LLC INTRANERVE, LLC INTRAOPS NEUROMONTORING, LLC IRON HORSE PEDIATRICS JACK D AIKIN, MD JAMES DAVID HARPSTER, CRNFA JAMES E BERWICK, DDS, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 13 of 24

JAMES PESHOCK, MD, PC JAMES PETTET DPM PC JAMES R DENTON, MD JAN ELIZABETH LEO, MD JDI SURGICAL JEFFREY LE SCHMIDT, MD JEFFREY LYNN HOLTGREWE, MD JEFFREY RONALD RAVAL, MD JEFFREY WILLIAMS, DO PC JESSE HOWARD BAKER, SA JOHN A. ROTHCHILD, DDS, PC JOHN ALAN LAMPE, MD JOHN BUFORD WOODWARD III MD, PC JOHN GARRETT HIGHFILL, MD JOHN M PAV MD PC JOSEPH P. ZUFALL, D.D.S. KAREN L DROZDA, CST CFSA KATHERINE KEMPF PARODI, DPM KATHY DITLOW CRNFA (INDEPENDENT CRNFA) KEITH A NAFTULIN, DPM, PC KENDRA L. PATTERSON, DMD, PC KESSLER-GENERAL SURGERY KEVIN EUGENE STEELE, CSA KEVIN J HEINZE, MD, PC KHOI DUY PHAM, MD KILSAN KOH, M.D., F.A.C.S. KRYSTAL J HOLDERNESS-NAKAMURA, MD LA PLATA FAMILY MEDICINE ASSOCIATES PC LADNER FACIAL PLASTIC & COSMETIC SURGERY LAFAYETTE PEDIATRICS AND INTERNAL MEDICINE LAKEWOOD EYE CLINIC, INC. LAURA M REICH MD LAWRENCE ANTHONY DAVIS, SA

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 14 of 24

LAWRENCE C. WANG, MD, P.C. LINDA JO PLATT, CST CFA LITTLETON FOOT AND ANKLE CLINIC, LLC LITTLETON PEDIATRIC MEDICAL CENTER LOCUMTENENS LONE TREE INTERNAL MEDICINE & PEDIATRICS LONE TREE PEDIATRICS LONE TREE SURGICAL ASSOCIATES, PC LONG TERM CARE & REHAB CONSULTANTS LLC LONGMONT ANESTHESIA ASSOCIATES LONGMONT CLINIC LONGMONT HOSPITALIST GROUP LONGMONT PULMONARY AND CRITICAL CARE ASSOCIATES LONGS PEAK FAMILY PRACTICE PC LOOK OPTICAL LOUISVILLE FOOT & ANKLE CLINIC MALAMUD SURGICAL SERVICES, INC. MAPLE LEAF ORTHOPEDICS MARC LEON SCHLESINGER, MD MARC M TREIHAFT MD MARGOLIS VISION MARK W HINMAN MD, LLC MARY JANE HOSCH CRNFA MATTHEW DIEHL HINDERLAND, DPM MATTHEWS-VU MEDICAL GROUP MCDONALD SURGICAL ASSISTING, L.L.C. MCVAY FOOT AND ANKLE, PC MEDICAL AND SURGICAL FOOT AND ANKLE PC MEDNAX MEDICAL GROUP MEDSURANT MONITORING MELISSA ANN VARRA, SA MELISSA YANOVER, MD- KIDNEY ASSOC OF CO PC MEMORIAL GENERAL AND VASCULAR SURGERY

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 15 of 24

METAMORPHOSIS, LTD METRO DENVER PAIN MANAGEMENT METROPOLITAN FOOT AND ANKLE METROPOLITAN PATHOLOGISTS MICHAEL A THOMPSON, RNFA, CNOR, INC MICHAEL A VOLZ, MD PC MICHAEL BATEMAN MD, PC MICHAEL CHARLES BATEMAN, MD MICHAEL DOUGLAS MIGNOLI MD PC MICHAEL JOHN HAWES, MD MICHAEL SCOTT SOLOMON, DO MIKHAIL DRUZHININ FIRST ASSISTANT SERVICES, INC MILE HIGH EYE INSTITUTE MILE HIGH PLASTIC SURGERY MILE HIGH SURGICAL ASSISTANT, INC MIND SPRINGS MOHAMMED ZUBAIR, MD MOUNTAIN BLUE CANCER CARE CENTER MOUNTAIN PEAKS UROLOGY, PC MOUNTAIN STATES PATHOLOGY MOUNTAIN VIEW SURGICAL ASSOCIATES MOUNTAIN VISTA FAMILY PRACTICE, PC MOUNTAINTOP DERMATOLOGY MUNNI RAMAIAH SELAGAMSETTY, MD MY KIDS DENTIST NANCY ANNE NELSON TAOKA, MD NATIONAL JEWISH CENTER NATIONAL NEUROMONITORING SERVICES, LLC NELSON AND ROLLERT ASSOCIATES IN ORAL MAXILLOFACIAL SURGERY PROF. NERVEWATCH, LLC NEUROLOGIC IOM NEUROLOGY OF THE ROCKIES PC NEUROMONITORING ASSOCIATES, LLC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 16 of 24

NEUROPHYSIOLOGIC, INC NEUROSURGICAL AND SPINE SPECIALISTS PC NEW WEST PHYSICIANS NORMAN P PAYEA, II, MD NORTH METRO INFECTIOUS DISEASE SPECIALIST, PC NORTH SPRINGS SURGICAL ASSOCIATES, PC NORTHERN COLORADO ANESTHESIA PROFESSIONALS, PLLC NORTHWEST EYE CENTER, P.C. NORTHWEST NEUROLOGY, PC NORTHWEST OMS NOVANT MEDICAL GROUP OBSTETRIX MEDICAL GROUP OF COLORADO, P C OCULOPLASTICS AND OPHTHALMOLOGY AT LITTLETON OLIVIA VYNN ADAIR, MD PC OMNI EYE SPECIALISTS OPTIMAL FUNCTIONING THROUGH PHYSIATRY OPTUM HEALTH/UNITED ORAL AND MAXILLOFACIAL SURGERY SPECIALISTS OF COLO SPGS ORAL SURGERY ASSOCIATES ORAL SURGERY CENTER ORAL SURGERY OF THE ROCKIES OSTEO RELIEF INSTITUTE OUR LADY OF HOPE MEDICAL CLINIC PAIN AND SPINE AT ST FRANCIS PAIN MANAGEMENT OF THE ROCKIES, PC PANKAJ NASHIKKAR MD, LLC PANORAMA ORTHOPEDICS, PC PARAMOUNT IOM, LLC PARK AVENUE OCULOPLASTIC SURGEONS, P.C PARK MEADOWS COSMETIC SURGERY PARKER HOSPITAL HEART FAILURE CLINIC PARKER PEDIATRICS & ADOLESCENTS, PC PARKVIEW FAMILY MEDICINE

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 17 of 24

PARKVIEW UROLOGY PAUL MACKELL MD PC PEAK ANESTHESIA & PAIN MANAGEMENT PEAK ENT AND VOICE CENTER PEAK NEUROLOGY, PC PEAK NEUROMONITORING LLC PEAK ORTHOPEDICS PEAK PEDIATRICS, LLC PEAK PERFUSION GROUP, INC PEAK VISTA COMMUNITY HEALTH CENTERS PEDIATRIC ASSOCIATES PEDIATRIC ASSOCIATES OF DURANGO, PC PEDIATRIC DENTAL SPECIALTIES PEDIATRIC PARTNERS OF THE SOUTHWEST PEDIATRIC PATHWAYS PEDIATRICS 5280 PEDIATRICS AT THE MEADOWS PENRAD IMAGING LLC PERFORMANCE CARDIOLOGY PETER A. MCINTYRE, DDS, PC PETER R YARNELL MD PC PHILIP CHARLES MARIN, MD PIKES PEAK ANESTHESIA PIKES PEAK HOSPICE & PALLIATIVE CARE PIKES PEAK NEPHROLOGY ASSOCIATES PIKE'S PEAK ORAL SURGERY PIKES PEAK ORTHOPAEDIC SURGERY AND SPORTS MEDICINE PIKES PEAK PHYSICAL MEDICINE PIKES PEAK UROLOGY PC PINE CREEK VISION CLINIC PINNACLE FOOT & ANKLE CLINIC PC PIUS KARU KAMAU, MD PLAZA MEDICAL CENTER-FAMILY PRACTICE

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 18 of 24

PODIATRY ASSOCIATES, PC PRECISION ORTHOPEDICS, PC PRECISION PLASTIC AND HAND SURGERY, LLC PRECISION SPINE CENTER PREMIER ANESTHESIA OF COLORADO PREMIER ORTHOPEDICS PREMIER SURGERY PREMIERE SURGEONS PRO ACTIVE PODIATRY PROFESSIONAL ALLIANCE SURGICAL ASSISTING PUEBLO ANKLE AND FOOT CARE, PLLC PUEBLO BONE & JOINT CLINIC PUEBLO COMMUNITY HEALTH CENTER, INC PUEBLO EAR, NOSE & THROAT CLINIC PUEBLO INFECTIOUS DISEASES PUEBLO PULMONARY ASSOCIATES PUEBLO RADIATION ONCOLOGY PUEBLO RADIOLOGICAL GROUP PULMONARY ASSOCIATES PURVI V SHAH, DDS PVMG LONGMONT CLINIC - INFECTIOUS DISEASE PVMG LONGMONT CLINIC - PEDIATRICS PVMG LONGMONT CLINIC-GENERAL SURGERY RADIATION ONCOLOGY PC RADIOLOGY ASSOCIATES OF DURANGO RADIOLOGY IMAGING ASSOCIATES PC RANDOLPH COLEMAN ROBINSON, MD, DDS REAL TIME NEUROMONITORING ASSOCIATES OF CALIFORNIA, PC REAL TIME NEUROMONITORING ASSOCIATES, PLLC RED ROCKS FOOT & ANKLE CENTER RED ROCKS OB/GYN RESTORATION PLASTIC SURGERY PC RETINA CONSULTANTS OF SOUTHERN COLORADO, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 19 of 24

REVALLA PLASTIC SURGERY RHONDA M JUDGE, CST, CSFA RIVERGATE ORTHOPEDICS AND ANIMAS UROLOGY, PC ROBERT BRUCE MCINTYRE, PHD ROBERT CHARLES GRIFFIN, RN, CNOR/CRNFA ROBERT GLENN FANTE, MD ROBERT LEE BLAYNEY, MD ROBERT SNYDER, MD ROBERT WAYNE SHERWOOD, CSA ROCK CANYON FOOT & ANKLE CLINIC, LLC ROCKY MOUNTAIN ADVANCED SPINE ACCESS ROCKY MOUNTAIN BRAIN & SPINE INSTITUTE ROCKY MOUNTAIN CANCER CENTERS LLP ROCKY MOUNTAIN EAR CENTER ROCKY MOUNTAIN ENT ROCKY MOUNTAIN EYE CENTER INC ROCKY MOUNTAIN FAMILY PRACTICE OF LEADVILLE ROCKY MOUNTAIN FERTILITY CENTER ROCKY MOUNTAIN FOOT & ANKLE CENTER ROCKY MOUNTAIN GASTROENTEROLOGY ASSOCIATES PLLC ROCKY MOUNTAIN HEALTH CENTERS PEDIATRICS PC ROCKY MOUNTAIN HOSPITAL FOR CHILDREN PSL ROCKY MOUNTAIN INFECTIOUS DISEASE SPECIALISTS PC ROCKY MOUNTAIN NEURODIAGNOSTICS ROCKY MOUNTAIN NEUROSURGERY ROCKY MOUNTAIN PAIN SOLUTIONS ROCKY MOUNTAIN PEDIATRIC ANESTHESIOLOGY PC ROCKY MOUNTAIN PEDIATRIC DENTISTRY, PC ROCKY MOUNTAIN PEDIATRIC GASTROENTEROLOGY ROCKY MOUNTAIN PEDIATRIC SURGERY ROCKY MOUNTAIN PEDIATRIC UROLOGY ROCKY MOUNTAIN PERFUSIONISTS ROCKY MOUNTAIN PRIMARY CARE

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 20 of 24

ROCKY MOUNTAIN RADIOLOGISTS, PC ROCKY MOUNTAIN RETINA ASSOCIATES ROCKY MOUNTAIN SPINE CLINIC PC ROCKY MOUNTAIN SURGICAL ASSISTS LLC ROCKY MOUNTAIN SURGICAL SUPPORT, INC. RON WAYNE PELTON, MD, PHD ROSA JUANITA CISNEROS, MD ROSS M. LEIBOVITZ, M.D., P.C. ROYAL GORGE EMERGENCY MEDICINE SPECIALISTS PC RUSSELL JAMES WEISTER, MD SAGE FAMILY MEDICINE SALUD FAMILY HEALTH SAN LUIS VALLEY FOOT AND ANKLE CLINIC SANGRE DE CRISTO HOSPICE SANTA FE ORAL SURGERY SCH-HEART CENTER SEMPER HEALTHCARE SENTIENT MEDICAL SYSTEMS SENTIENT PHYSICIANS, P.C SENTINEL NEUROMONITORING, LLC SHARON MARRS KESSLER, MD SHARP PODIATRIC MEDICINE AND SURGERY SHELLEI MITCHELL SURGICAL ASSISTING, LLC SHERIDAN CHILDREN'S HEALTHCARE SERVICES SIGHTPATH MEDICAL SIMPLY KIDS DENTAL SKIN CANCER AND DERMATOLOGY CENTER SKIN MD DERMATOLOGY & SKIN ENHANCEMENT CENTER SMALL WORLD PEDIATRICS SONOBELLO SOUND INPATIENT PHYSICIANS SOUND VASCULAR & VEIN SOUTH DENVER CARDIOLOGY ASSOCIATES

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 21 of 24

SOUTH DENVER ENT AND ALLERGY SOUTH DENVER GASTROENTEROLOGY, PC SOUTH DENVER NEUROSURGERY SOUTH DENVER OB/GYN, PC SOUTH DENVER PHYSICIANS PLLC SOUTH DENVER SPINE PC SOUTHERN COLORADO CLINIC SOUTHERN COLORADO CLINIC (FAMILY PRACTICE) SOUTHERN COLORADO EMERGENCY SPECIALISTS SOUTHERN COLORADO NEPHROLOGY ASSOCIATES SOUTHERN COLORADO PSYCHIATRIC, PC SOUTHERN WAY SURGICAL INC SOUTHPARK INTERNAL MEDICINE, PC SOUTHWEST COLORADO EAR NOSE & THROAT ASSOCIATES SOUTHWEST DIAGOSTICS LABS SOUTHWEST EMERGENCY PHYSICIANS SOUTHWEST MIDWIVES SOUTHWEST RETINA CONSULTANTS, PC SPECIALTY CARE SPECIALTYCARE SPECIALTYCARE IOM SERVICES LLC SPINAL DIAGNOSTICS & PAIN MANAGEMENT SPINE COLORADO SPINE, PAIN & REHABILITATION CENTER OF CO SPORTS AND ORTHOPEDIC REHABILITATION PLLC SPRINGS REHABILITATION STATCALL SURGICAL ASSISTING INC STEADMAN HAWKINS CLINIC STEPHANIA KAY TIMOTHY, MD STEPHEN MATTHEW SCHACHT, DDS STEPHEN VIALPANDO MD STEPPING STONE PEDIATRICS STEVEN CLARK KINNETT, MD

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 22 of 24

STEVENS COUNTY MEDICAL CLINIC STRATA ANESTHESIA SUMANT RAWAT, MD SUMMIT HOSPITALISTS SUMMIT MEDICAL CLINIC SUMMIT PEDIATRIC DENTAL SPECIALTIES SURGERY SPECIALISTS OF FREMONT COUNTY SURGICAL ASSIST SERVICES SURGICAL CONSULTANTS OF AURORA, PC SURGONE PC SWAN MOUNTAIN WOMEN'S CENTER, PC TABLE MOUNTAIN FOOT & ANKLE TAD R HEINZ, MD PC TANYA A. ATAGI, MD TAYLOR FIRST ASSISTING SERVICES, LLC TED PULS MD, PC THE CENTRE FOR BEHAVIORAL HEALTH THE CHILDREN'S HOSPITAL COLORADO THE COLORADO FOOT AND ANKLE CLINIC THE COLORADO RETINA CENTER THE EYE CENTER THE LITTLETON CLINIC THE PAIN & REHAB INSTITUTE THE UROLOGY CENTER OF COLORADO THE WOMEN'S HEALTH GROUP THE WRIGHT EYE CENTER THOMAS ALLAN POLITZER, OD THOMAS E. BOWSER MD PLLC TIMOTHY F. STACEY, DDS TOMASETTI AND MCLAIN ORAL MAXILLOFACIAL SURGERY TOXICOLOGY ASSOCIATES TRANSITIONS CHRONIC CARE TRAUMA AND EMERGENCY SUBSPECIALTY SURGEONS

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 23 of 24

TRENT HOVENGA, MD, PC TRU COMMUNITY CARE UCHEALTH LITTLETON CANCER CENTER ULYSSES FAMILY PHYSICIANS UNIPATH UNITED MEDICAL SYSTEM/US LITHOTRIPSY UNITED PATHOLOGY SERVICES PC UNIVERSITY OF COLORADO ANSCHUTZ CANCER CENTER UNIVERSITY OF COLORADO DEPARTMENT OF NEUROSURGERY UNIVERSITY OF COLORADO HEALTH SCIENCE CENTER UNIVERSITY OF COLORADO HOSPITAL UNIVERSITY OF COLORADO MEMORIAL HEALTH SYSTEMS UNIVERSITY OF COLORADO SCHOOL OF DENTAL MEDICINE UNIVERSITY PHYSICIANS INCORPORATED UROLOGICAL ASSOCIATES, PC UROLOGY ASSOCIATES, PC UROLOGY CLINIC PC UROLOGY CONSULTANTS, PC UROLOGY OF PUEBLO, PC US ACUTE CARE SOLUTIONS OF COLORADO US AIR FORCE ACADEMY US ANESTHESIA PARTNERS VAIL-SUMMIT ORTHOPAEDICS PC VANDNA JERATH, MD VANGUARD SKIN SPECIALISTS VASCULAR INSTITUTE OF THE ROCKIES VELOCITY NEUROCARE LLC VICTOR S CHAVEZ-ABRAHAM, SA, RN VIGILANT ANESTHESIA PROVIDERS OF THE ROCKIES, PC VILLAGE PEDIATRICS VISION CARE SPECIALISTS, PC VISIONAIRE EYE CONSULTANTS W J GAREHIME, PC

All official Centura Health policies are maintained electronically and are subject to change. No printed policy should be taken as the official policy except to the extent it is consistent with the current policy that is electronically maintained. Category – Statewide Financial Assistance Policy Page 24 of 24

WAINUI, PC WELLSPRING FAMILY HEALTHCARE WESTERN INFECTIOUS DISEASE CONSULTANTS PC WESTERN NEPHROLOGY AND METABOLIC BONE DISEASE WESTERN ORTHOPAEDIC PC WESTSIDE WOMEN'S CARE WHEAT RIDGE GENERAL & VASCULAR SURGICAL ASSOC. PC WILEY JUNIOR JINKINS, III, MD WILLIAM G RAINER, JR, M.D., PA WOMEN'S HEALTH WISE YONG ZHOU, RN, CSA YOUNG AT HEART DENTISTRY ZWIEBEL CENTER FOR PLASTIC SURGERY