ALBERTA HEALTH CARE INSURANCE PLAN Schedule of … · ALBERTA HEALTH CARE INSURANCE PLAN Page 1 ....

ALBERTA HEALTH CARE INSURANCE PLAN Schedule of Anaesthetic Rates Applicable to Dentistry Price List As Of 01 October 2019

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ALBERTA HEALTH CARE INSURANCE PLAN Page i Generated 2019/07/18 TABLE OF CONTENTS As of 2019/10/01 I. CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES . . . . . . . . . . . . . . . . . 1 01 NONOPERATIVE ENDOSCOPY . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 01.0 Nonoperative endoscopy of respiratory tract . . . . . . . . . . . . . . . 1 01.3 Other nonoperative endoscopy . . . . . . . . . . . . . . . . . . . . . . 1 II. OPERATIONS ON THE NERVOUS SYSTEM . . . . . . . . . . . . . . . . . . . . . . . 1 15 OTHER OPERATIONS ON SKULL, BRAIN, AND CEREBRAL MENINGES . . . . . . . . . . . 1 15.0 Cranioplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 17 OPERATIONS ON CRANIAL AND PERIPHERAL NERVES . . . . . . . . . . . . . . . . . 2 17.0 Incision, division, and excision of cranial and peripheral nerves . . . . 2 17.1 Destruction of cranial and peripheral nerves . . . . . . . . . . . . . . 2 17.2 Suture of cranial and peripheral nerves . . . . . . . . . . . . . . . . . 3 17.3 Freeing of adhesions and decompression of cranial and peripheral nerves . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 17.5 Transposition of cranial and peripheral nerves . . . . . . . . . . . . . 4 17.7 Injection into peripheral nerve . . . . . . . . . . . . . . . . . . . . . 4 VI. OPERATIONS ON NOSE, MOUTH, AND PHARYNX . . . . . . . . . . . . . . . . . . . . 5 33 OPERATIONS ON NOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 33.0 Control of epistaxis . . . . . . . . . . . . . . . . . . . . . . . . . . 5 33.4 Submucous resection of nasal septum . . . . . . . . . . . . . . . . . . . 5 33.6 Reduction of nasal fracture . . . . . . . . . . . . . . . . . . . . . . . 5 33.7 Repair and plastic operations on the nose . . . . . . . . . . . . . . . . 6 34 OPERATIONS ON NASAL SINUSES . . . . . . . . . . . . . . . . . . . . . . . . . 8 34.1 Intranasal antrotomy . . . . . . . . . . . . . . . . . . . . . . . . . . 8 34.6 Repair and plastic operation of nasal sinus . . . . . . . . . . . . . . . 8 35 REMOVAL AND RESTORATION OF TEETH . . . . . . . . . . . . . . . . . . . . . . 10 35.0 Forceps extraction of tooth (multiple) (single) . . . . . . . . . . . . 10 36 OTHER OPERATIONS ON TEETH, GUMS, AND ALVEOLI . . . . . . . . . . . . . . . 10 36.3 Excision of dental lesion of jaw . . . . . . . . . . . . . . . . . . . 10 36.6 Application of orthodontic appliance . . . . . . . . . . . . . . . . . . 12 36.7 Other orthodontic operation . . . . . . . . . . . . . . . . . . . . . . 13 37 OPERATIONS ON TONGUE . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 37.1 Partial glossectomy . . . . . . . . . . . . . . . . . . . . . . . . . . 13

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ALBERTA HEALTH CARE INSURANCE PLAN Page ii Generated 2019/07/18 TABLE OF CONTENTS As of 2019/10/01 37.2 Complete glossectomy . . . . . . . . . . . . . . . . . . . . . . . . . 14 37.4 Repair and plastic operations on tongue . . . . . . . . . . . . . . . . 14 37.8 Invasive diagnostic procedures on tongue . . . . . . . . . . . . . . . 14 37.9 Other operations on tongue . . . . . . . . . . . . . . . . . . . . . . 14 38 OPERATIONS ON SALIVARY GLANDS AND DUCTS . . . . . . . . . . . . . . . . . . 15 38.0 Incision of salivary gland or duct . . . . . . . . . . . . . . . . . . 15 38.1 Excision of lesion of salivary gland . . . . . . . . . . . . . . . . . 15 38.2 Sialoadenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 38.9 Other operations on salivary gland or duct . . . . . . . . . . . . . . 16 39 OTHER OPERATIONS ON MOUTH AND FACE . . . . . . . . . . . . . . . . . . . . 17 39.0 Drainage of face or floor of mouth . . . . . . . . . . . . . . . . . . 17 39.1 Incision of palate . . . . . . . . . . . . . . . . . . . . . . . . . . 17 39.2 Excision of lesion or tissue of palate . . . . . . . . . . . . . . . . 18 39.4 Plastic repair of mouth (internal) . . . . . . . . . . . . . . . . . . 18 39.5 Palatoplasty . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 39.8 Invasive diagnostic procedures on oral cavity . . . . . . . . . . . . . 20 39.9 Other operations on mouth and face . . . . . . . . . . . . . . . . . . 20 41 OPERATIONS ON PHARYNX . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 41.3 Plastic operation on pharynx . . . . . . . . . . . . . . . . . . . . . 21 43 OTHER OPERATIONS ON LARYNX AND TRACHEA . . . . . . . . . . . . . . . . . . 21 43.1 Temporary tracheostomy . . . . . . . . . . . . . . . . . . . . . . . . 21 46 OPERATIONS ON CHEST WALL, PLEURA, MEDIASTINUM, AND DIAPHRAGM . . . . . . . 22 46.0 Incision of chest wall and pleura . . . . . . . . . . . . . . . . . . . 22 VIII. OPERATIONS ON THE CARDIOVASCULAR SYSTEM . . . . . . . . . . . . . . . . . 22 51 OTHER OPERATIONS ON VESSELS . . . . . . . . . . . . . . . . . . . . . . . . 22 51.9 Other operations on vessels . . . . . . . . . . . . . . . . . . . . . . 22 XV. OPERATIONS ON THE MUSCULOSKELETAL SYSTEM . . . . . . . . . . . . . . . . . . 22 88 OPERATIONS ON FACIAL BONES AND JOINTS . . . . . . . . . . . . . . . . . . . 22 88.0 (Closed) reduction of facial fractures . . . . . . . . . . . . . . . . 22 88.1 Open reduction of facial fractures . . . . . . . . . . . . . . . . . . 24 88.2 Incision of facial bone without division . . . . . . . . . . . . . . . 28 88.4 Partial ostectomy of facial bone, except mandible . . . . . . . . . . . 34 88.5 Excision and reconstruction of mandible . . . . . . . . . . . . . . . . 34

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ALBERTA HEALTH CARE INSURANCE PLAN Page iii Generated 2019/07/18 TABLE OF CONTENTS As of 2019/10/01 88.6 Temporomandibular arthroplasty . . . . . . . . . . . . . . . . . . . . 34 88.7 Other facial bone repair and osteoplasty . . . . . . . . . . . . . . . 38 88.8 Invasive diagnostic procedures on facial bones . . . . . . . . . . . . 39 XV. OPERATIONS ON THE MUSCULOSKELETAL SYSTEM . . . . . . . . . . . . . . . . . . 39 88 OPERATIONS ON FACIAL BONES AND JOINTS . . . . . . . . . . . . . . . . . . . 39 89 INCISION, EXCISION, AND DIVISION OF OTHER BONES . . . . . . . . . . . . . . 41 89.0 Sequestrectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 90 OTHER OPERATIONS ON BONES EXCEPT FACIAL BONES . . . . . . . . . . . . . . . 41 90.6 Removal of internal fixation device . . . . . . . . . . . . . . . . . . 41 92 INCISION AND EXCISION OF JOINT STRUCTURES . . . . . . . . . . . . . . . . . 41 92.4 Synovectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 93 REPAIR AND PLASTIC OPERATIONS ON JOINT STRUCTURES . . . . . . . . . . . . . 42 93.9 Other operations on joints . . . . . . . . . . . . . . . . . . . . . . 42 95 OPERATIONS ON MUSCLES, TENDONS, FASCIA, AND BURSA, EXCEPT HAND . . . . . . 42 95.0 Incision of muscle, tendon, fascia and bursa . . . . . . . . . . . . . 42 XVII. OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE . . . . . . . . . . . . . . . . 42 98 OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE . . . . . . . . . . . . . . . . 42 98.1 Excision of skin and subcutaneous tissue . . . . . . . . . . . . . . . 42 98.3 Relaxation of scar or contracture of skin . . . . . . . . . . . . . . . 44 98.5 Flap or pedicle graft . . . . . . . . . . . . . . . . . . . . . . . . . 45 98.6 Plastic operations on lip and external mouth . . . . . . . . . . . . . 45 XVIII. PROCEDURES NOT ELSEWHERE CLASSIFIED . . . . . . . . . . . . . . . . . . . 46 99 PROCEDURES NOT ELSEWHERE CLASSIFIED . . . . . . . . . . . . . . . . . . . . 46 99.0 Ill-defined operations . . . . . . . . . . . . . . . . . . . . . . . . 46

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ALBERTA HEALTH CARE INSURANCE PLAN Page 1 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 I. CERTAIN DIAGNOSTIC AND THERAPEUTIC PROCEDURES 01 NONOPERATIVE ENDOSCOPY 01.0 Nonoperative endoscopy of respiratory tract ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 01.01DA 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 104.34 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 01.05DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 01.3 Other nonoperative endoscopy -------------------------------------------------------------------------------------------------- 01.32D 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.31 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 01.39A 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- II. OPERATIONS ON THE NERVOUS SYSTEM 15 OTHER OPERATIONS ON SKULL, BRAIN, AND CEREBRAL MENINGES 15.0 Cranioplasty --------------------------------------------------------------------------------------------------

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15.03A 0.00 BMI BMIANE Y Increase By 25% 14

ALBERTA HEALTH CARE INSURANCE PLAN Page 2 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 15.03A (cont'd) BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 305.76 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17 OPERATIONS ON CRANIAL AND PERIPHERAL NERVES 17.0 Incision, division, and excision of cranial and peripheral nerves -------------------------------------------------------------------------------------------------- 17.08L 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.08M 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.08N 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.1 Destruction of cranial and peripheral nerves -------------------------------------------------------------------------------------------------- 17.1 E 0.00 BMI BMIANE Y Increase By 25% 14

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BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21

ALBERTA HEALTH CARE INSURANCE PLAN Page 3 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 17.1 E (cont'd) ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.2 Suture of cranial and peripheral nerves -------------------------------------------------------------------------------------------------- 17.2 E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 576.58 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.2 F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.2 G 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 262.08 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.2 H 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 436.81 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 4 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 17.3 Freeing of adhesions and decompression of cranial and peripheral nerves ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 17.32D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 262.08 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.5 Transposition of cranial and peripheral nerves -------------------------------------------------------------------------------------------------- 17.5 C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.7 Injection into peripheral nerve -------------------------------------------------------------------------------------------------- 17.7 A 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.7 B 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 17.7 C 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 5 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 17.7 C (cont'd) ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- VI. OPERATIONS ON NOSE, MOUTH, AND PHARYNX 33 OPERATIONS ON NOSE 33.0 Control of epistaxis -------------------------------------------------------------------------------------------------- 33.02DA 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.02DB 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.05DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 183.46 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.4 Submucous resection of nasal septum -------------------------------------------------------------------------------------------------- 33.4 B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.6 Reduction of nasal fracture

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ALBERTA HEALTH CARE INSURANCE PLAN Page 6 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 33.61B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 VANE ADDA Replace 109.21 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.62C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 183.46 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.62E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 183.46 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.62DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.62DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 384.39 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.7 Repair and plastic operations on the nose -------------------------------------------------------------------------------------------------- 33.76DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 7 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 33.76DA (cont'd) ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 131.04 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 131.04 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DD 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DE 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DF 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DG 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77

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ALBERTA HEALTH CARE INSURANCE PLAN Page 8 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 33.76DG (cont'd) ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 33.76DH 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 314.50 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 34 OPERATIONS ON NASAL SINUSES 34.1 Intranasal antrotomy -------------------------------------------------------------------------------------------------- 34.1 B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 34.6 Repair and plastic operation of nasal sinus -------------------------------------------------------------------------------------------------- 34.61A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 159.01 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 34.61B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 157.25 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 9 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 34.61B (cont'd) SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 34.61C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 159.01 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 34.61D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 157.25 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 34.61E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 157.25 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 34.61F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 167.83 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 10 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 35 REMOVAL AND RESTORATION OF TEETH 35.0 Forceps extraction of tooth (multiple) (single) ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 35.0 DA 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.31 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36 OTHER OPERATIONS ON TEETH, GUMS, AND ALVEOLI 36.3 Excision of dental lesion of jaw -------------------------------------------------------------------------------------------------- 36.3 B 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.31 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.79 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 11 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 36.3 E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 M 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.79 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 185.51 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 G 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.39 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 H 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 202.64 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 12 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 36.3 H (cont'd) ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 J 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 K 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 257.90 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.3 L 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 220.84 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.6 Application of orthodontic appliance -------------------------------------------------------------------------------------------------- 36.6 A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 279.96 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 50% 2ANU 2ANU 1 For Each Call Increase By 1.00 2-150 For Each Call Increase By 22.07 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 13 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 36.6 A (cont'd) SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.7 Other orthodontic operation -------------------------------------------------------------------------------------------------- 36.7 A 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 36.7 B 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37 OPERATIONS ON TONGUE 37.1 Partial glossectomy -------------------------------------------------------------------------------------------------- 37.1 DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.28 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37.1 DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 259.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 14 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 37.2 Complete glossectomy ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 37.2 D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 576.58 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37.4 Repair and plastic operations on tongue -------------------------------------------------------------------------------------------------- 37.49A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37.8 Invasive diagnostic procedures on tongue -------------------------------------------------------------------------------------------------- 37.81D 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37.9 Other operations on tongue -------------------------------------------------------------------------------------------------- 37.91DA 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37.91DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 15 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 37.91DB (cont'd) ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 37.99B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38 OPERATIONS ON SALIVARY GLANDS AND DUCTS 38.0 Incision of salivary gland or duct -------------------------------------------------------------------------------------------------- 38.0 B 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.0 C 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.0 D 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.31 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.1 Excision of lesion of salivary gland -------------------------------------------------------------------------------------------------- 38.19A 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 16 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 38.19A (cont'd) ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-3 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.19B 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.19D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 150.17 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.2 Sialoadenectomy -------------------------------------------------------------------------------------------------- 38.21DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 167.83 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 38.9 Other operations on salivary gland or duct -------------------------------------------------------------------------------------------------- 38.91A 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83

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ALBERTA HEALTH CARE INSURANCE PLAN Page 17 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 38.91A (cont'd) SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39 OTHER OPERATIONS ON MOUTH AND FACE 39.0 Drainage of face or floor of mouth -------------------------------------------------------------------------------------------------- 39.0 A 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.0 B 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.0 C 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 145.74 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.1 Incision of palate -------------------------------------------------------------------------------------------------- 39.1 A 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 18 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 39.2 Excision of lesion or tissue of palate ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 39.21B 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.21C 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.4 Plastic repair of mouth (internal) -------------------------------------------------------------------------------------------------- 39.41 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.5 Palatoplasty -------------------------------------------------------------------------------------------------- 39.52E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.52F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 192.20

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ALBERTA HEALTH CARE INSURANCE PLAN Page 19 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 39.52F (cont'd) ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.52H 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.52J 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.52DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 331.97 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 39.52DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 483.56 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.52DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 483.56 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 20 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 39.52DC (cont'd) 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.59B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 323.24 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.8 Invasive diagnostic procedures on oral cavity -------------------------------------------------------------------------------------------------- 39.83C 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.83D 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 141.34 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.9 Other operations on mouth and face -------------------------------------------------------------------------------------------------- 39.91DB 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.91DC 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 21 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 39.91DC (cont'd) ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.92A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.53 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 39.99B 0.00 BMI BMIANE Y Increase By 25% G BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 41 OPERATIONS ON PHARYNX 41.3 Plastic operation on pharynx -------------------------------------------------------------------------------------------------- 41.3 C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 43 OTHER OPERATIONS ON LARYNX AND TRACHEA 43.1 Temporary tracheostomy -------------------------------------------------------------------------------------------------- 43.1 DA 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 22 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 43.1 DB 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 46 OPERATIONS ON CHEST WALL, PLEURA, MEDIASTINUM, AND DIAPHRAGM 46.0 Incision of chest wall and pleura -------------------------------------------------------------------------------------------------- 46.04DA 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- VIII. OPERATIONS ON THE CARDIOVASCULAR SYSTEM 51 OTHER OPERATIONS ON VESSELS 51.9 Other operations on vessels -------------------------------------------------------------------------------------------------- 51.98B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 141.34 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- XV. OPERATIONS ON THE MUSCULOSKELETAL SYSTEM 88 OPERATIONS ON FACIAL BONES AND JOINTS 88.0 (Closed) reduction of facial fractures -------------------------------------------------------------------------------------------------- 88.02C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 50% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 23 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.02C (cont'd) SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP50 Y Reduce Base To 50% -------------------------------------------------------------------------------------------------- 88.03B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 176.68 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 50% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP50 Y Reduce Base To 50% -------------------------------------------------------------------------------------------------- 88.04C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 184.21 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 50% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP50 Y Reduce Base To 50% -------------------------------------------------------------------------------------------------- 88.04DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 353.34 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.04DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 916.22 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.09B 0.00 BMI BMIANE Y Increase By 25% 14

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ALBERTA HEALTH CARE INSURANCE PLAN Page 24 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.09B (cont'd) BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 163.96 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 50% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP50 Y Reduce Base To 50% -------------------------------------------------------------------------------------------------- 88.1 Open reduction of facial fractures -------------------------------------------------------------------------------------------------- 88.12DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 454.27 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.12DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 607.91 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.12DD 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 803.71 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.12F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.79 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 25 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.12F (cont'd) ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.12G 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.12H 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.12J 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.13DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1170.62 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 26 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 88.13F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 218.39 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-3 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.13J 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 646.47 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.14DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 401.85 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.14DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 471.75 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.14DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 512.35 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.14J 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 441.68 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 27 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.14J (cont'd) ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.14K 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 653.70 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.14L 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 674.05 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.16DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 803.71 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.16C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.16D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 28 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.16D (cont'd) ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 100% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.19DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 978.43 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.2 Incision of facial bone without division -------------------------------------------------------------------------------------------------- 88.29C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 331.97 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1153.16 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 618.34 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29H 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 611.52 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 29 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.29H (cont'd) ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29M 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 601.19 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29T 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 611.52 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29U 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1202.38 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29V 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 644.75 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29X 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1065.80 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 30 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 88.29Y 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1083.27 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 803.71 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.29DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 873.60 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.29DD 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 700.02 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.29DE 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 803.71 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.29DF 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 663.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 31 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 88.29DG 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 765.15 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.29CA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 671.35 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 663.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29N 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1415.24 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29FA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1572.48 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29GA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 567.84 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 32 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.29GA (cont'd) SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29HA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1083.27 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29TA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 628.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29MA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 611.52 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29NA 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 157.25 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29PA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 145.74 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83

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ALBERTA HEALTH CARE INSURANCE PLAN Page 33 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.29PA (cont'd) SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29QA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29RA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 139.77 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29SA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29DH 0.00 BMI BMIANE Y Increase By 25% 14 ROLE ANE Y Replace Base 109.21 -------------------------------------------------------------------------------------------------- 88.29DJ 0.00 BMI BMIANE Y Increase By 25% 14 ROLE ANE Y Replace Base 109.21 -------------------------------------------------------------------------------------------------- 88.29DP 0.00 BMI BMIANE Y Increase By 25% 14 ROLE ANE Y Replace Base 109.21 -------------------------------------------------------------------------------------------------- 88.29DK 0.00 BMI BMIANE Y Increase By 25% 14 ROLE ANE Y Replace Base 109.21 -------------------------------------------------------------------------------------------------- 88.29DL 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 131.04 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83

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ALBERTA HEALTH CARE INSURANCE PLAN Page 34 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.29DL (cont'd) SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29DM 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 209.65 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.29DN 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 297.01 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.4 Partial ostectomy of facial bone, except mandible -------------------------------------------------------------------------------------------------- 88.4 DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 419.33 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.5 Excision and reconstruction of mandible -------------------------------------------------------------------------------------------------- 88.51DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 916.22 ROLE 2ANES Y Replace Base 22.07 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 Temporomandibular arthroplasty -------------------------------------------------------------------------------------------------- 88.6 C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 131.04 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 35 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.6 C (cont'd) ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 J 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 183.46 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 FA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 183.46 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 P 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 331.97 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 Q 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 148.51 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83

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ALBERTA HEALTH CARE INSURANCE PLAN Page 36 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.6 Q (cont'd) SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 R 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 323.24 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 S 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 331.97 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 U 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 323.24 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 V 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 331.97 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 W 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 37 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.6 W (cont'd) ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 X 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 856.13 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 Y 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 209.65 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 Z 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 157.25 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 CA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.31 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 471.75 ROLE ANEST Y Replace Base 18.39

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ALBERTA HEALTH CARE INSURANCE PLAN Page 38 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.6 DA (cont'd) ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.6 EA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 489.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.7 Other facial bone repair and osteoplasty -------------------------------------------------------------------------------------------------- 88.71B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 349.44 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.71C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 323.24 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.71D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 192.20 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 39 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 88.76B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.76DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 663.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.77A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 182.17 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 88.77DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 692.28 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.8 Invasive diagnostic procedures on facial bones -------------------------------------------------------------------------------------------------- 88.81A 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 141.34 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 40 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- 88.92C 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 50% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP50 Y Reduce Base To 50% -------------------------------------------------------------------------------------------------- 88.93D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 838.01 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.93E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 1170.62 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 CMPD CMPD Y Increase Base To 150% SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.93F 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.93G 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 349.44 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 88.97A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 212.00

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ALBERTA HEALTH CARE INSURANCE PLAN Page 41 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT 88.97A (cont'd) ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 89 INCISION, EXCISION, AND DIVISION OF OTHER BONES 89.0 Sequestrectomy -------------------------------------------------------------------------------------------------- 89.09C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 89.09D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 192.20 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 90 OTHER OPERATIONS ON BONES EXCEPT FACIAL BONES 90.6 Removal of internal fixation device -------------------------------------------------------------------------------------------------- 90.6 DD 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 331.97 ROLE 2ANES Y Replace Base 22.07 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 92 INCISION AND EXCISION OF JOINT STRUCTURES 92.4 Synovectomy

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ALBERTA HEALTH CARE INSURANCE PLAN Page 42 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 92.49A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 93 REPAIR AND PLASTIC OPERATIONS ON JOINT STRUCTURES 93.9 Other operations on joints -------------------------------------------------------------------------------------------------- 93.91DA 0.00 BMI BMIANE Y Increase By 25% M+ BMI BMI2AN Y Increase By 25% ROLE ANE Y Replace Base 458.11 ROLE 2ANES Y Replace Base 22.07 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% 2ANU 2ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 22.07 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 93.96A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.94 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 95 OPERATIONS ON MUSCLES, TENDONS, FASCIA, AND BURSA, EXCEPT HAND 95.0 Incision of muscle, tendon, fascia and bursa -------------------------------------------------------------------------------------------------- 95.02B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 43 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 XVII. OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE 98 OPERATIONS ON SKIN AND SUBCUTANEOUS TISSUE 98.1 Excision of skin and subcutaneous tissue ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------- 98.11DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 147.37 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.11DC 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.12DN 0.00 BMI BMIANE Y Increase By 25% M BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.12DP 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 122.30 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 98.13DB 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 109.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 44 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 98.3 Relaxation of scar or contracture of skin ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 98.3 A 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 110.43 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.3 B 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 297.01 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.3 C 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 406.35 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.3 D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 349.44 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.3 E 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 489.21 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75%

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ALBERTA HEALTH CARE INSURANCE PLAN Page 45 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 98.5 Flap or pedicle graft ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 98.5 DA 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 200.94 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.51D 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 297.01 ROLE ANEST Y Replace Base 18.39 ANEU ANEU 1 For Each Call Pay Base At 100% 2-2 For Each Call Pay Base At 75% ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 LVP LVP75 Y Reduce Base To 75% -------------------------------------------------------------------------------------------------- 98.6 Plastic operations on lip and external mouth -------------------------------------------------------------------------------------------------- 98.6 DA 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 98.6 DB 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 98.6 DC 0.00 BMI BMIANE Y Increase By 25% 4 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70

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ALBERTA HEALTH CARE INSURANCE PLAN Page 46 Schedule of Anaesthetic Rates Applicable to Dentistry Generated 2019/07/18 Part D - Price List As of 2019/10/01 ---------------------- MODIFIER --------------------- HSC BASE RATE TYPE CODE EXPLCT ACTION AMOUNT CAT -------------------------------------------------------------------------------------------------- 98.6 DD 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 157.25 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 98.6 DE 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 174.72 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 98.6 DF 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- 98.6 DG 0.00 BMI BMIANE Y Increase By 25% 14 BMI BMIANT Y Increase By 25% ROLE ANE Y Replace Base 165.98 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70 -------------------------------------------------------------------------------------------------- XVIII. PROCEDURES NOT ELSEWHERE CLASSIFIED 99 PROCEDURES NOT ELSEWHERE CLASSIFIED 99.0 Ill-defined operations -------------------------------------------------------------------------------------------------- 99.09S 0.00 BMI BMIANT Y Increase By 25% 14 ROLE ANEST Y Replace Base 18.39 ANU ANU 1 For Each Call Pay Base At 100% 2-150 For Each Call Increase By 18.39 SURC EV Y Increase By 48.70 SURC NTAM Y Increase By 116.83 SURC NTPM Y Increase By 116.83 SURC WK Y Increase By 48.70

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