Oxygen Supplies and Equipment

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DMEPOS Competitive Bidding Program Bid Preparation Worksheet Round 2 & Bid Calculations Oxygen Supplies and Equipment ***Please read the important information provided on page 4 before proceeding to the page(s) for a specific competitive bidding area.*** Akron, OH 4 Albany-Schenectady-Troy, NY 5 Albuquerque, NM 5 Allentown-Bethlehem-Easton, PA-NJ 6 Asheville, NC 6 Atlanta-Sandy Springs-Marietta, GA 7 Augusta-Richmond y, GA-SC 7 Austin-Round Rock-San Marcos, TX 8 Bakersfield-Delano, CA 8 Baltimore-Towson, MD 9 Baton Rouge, LA 10 Beaumont-Port Arthur, TX 10 Birmingham-Hoover, AL 11 Boise City-Nampa, ID 11 Boston-Cambridge-Quincy, MA-NH 12 Bridgeport-Stamford-Norwalk, CT 12 Bronx-Manhattan NY CBA 13 Buffalo-Niagara Falls, NY 13 Cape Coral-Fort Myers, FL 14 Central-Chicago Metro CBA 15 Charleston-North Charleston-Summerville, SC 15 Chattanooga, TN-GA 16 Colorado Springs, CO 16 Columbia, SC 17 Columbus, OH 17 Dayton, OH 18 Deltona-Daytona Beach-Ormond Beach, FL 18 Denver-Aurora-Broomfield, CO 19 Detroit-Warren-Livonia, MI 20 El Paso, TX 20 Flint, MI 21

Fresno, CA 21 Grand Rapids-Wyoming, MI 22 Greensboro-High Point, NC 22 Greenville-Mauldin-Easley, SC 23 Hartford-West Hartford-East Hartford, CT 23 Honolulu, HI 24 Houston-Sugar Land-Baytown, TX 25 Huntington-Ashland, WV-KY-OH 25 Indiana-Chicago Metro CBA 26 Indianapolis-Carmel, IN 26 Jackson, MS 27 Jacksonville, FL 27 Knoxville, TN 28 Lakeland-Winter Haven, FL 28 Las Vegas-Paradise, NV 29 Little Rock-North Little Rock-Conway, AR 30 Los Angeles y CBA 30 Louisville/Jefferson y, KY-IN 31 McAllen-Edinburg-Mission, TX 31 Memphis, TN-MS-AR 32 Milwaukee-Waukesha-West Allis, WI 32 Minneapolis-St. Paul-Bloomington, MN-WI 33 Nashville-Davidson--Murfreesboro--Franklin, TN 33 Nassau-Brooklyn-Queens-Richmond y Metro CBA 34 New Haven-Milford, CT 35 New Orleans-Metairie-Kenner, LA 35 North East NY CBA Metro 36 North Port-Bradenton-Sarasota, FL 36 Northern NJ Metro CBA 37 Northern-Chicago Metro CBA 37 Ocala, FL 38 Oklahoma City, OK 38 Omaha-Council Bluffs, NE-IA 39 Orange y CBA 40 Oxnard-Thousand Oaks-Ventura, CA 40 Palm Bay-Melbourne-Titusville, FL 41 Philadelphia-Camden-Wilmington, PA-NJ-DE-MD 41 Phoenix-Mesa-Glendale, AZ 42

Portland-Vancouver-Hillsboro, OR-WA 42 Poughkeepsie-Newburgh-Middletown, NY 43 Providence-New Bedford-Fall River, RI-MA 43 Raleigh-Cary, NC 44 Richmond, VA 45 Rochester, NY 45 Sacramento--Arden-Arcade--Roseville, CA 46 Salt Lake City, UT 46 San Antonio-New Braunfels, TX 47 San Diego-Carlsbad-San Marcos, CA 47 San Francisco-Oakland-Fremont, CA 48 San Jose-Sunnyvale-Santa Clara, CA 48 Scranton--Wilkes-Barre, PA 49 Seattle-Tacoma-Bellevue, WA 50 South-West-Chicago-Metro CBA 50 Southern NY Metro CBA 51 Springfield, MA 51 St. Louis, MO-IL 52 Stockton, CA 52 Suffolk y CBA 53 Syracuse, NY 53 Tampa-St. Petersburg-Clearwater, FL 54 Toledo, OH 55 Tucson, AZ 55 Tulsa, OK 56 Virginia Beach-Norfolk-Newport News, VA-NC 56 Visalia-Porterville, CA 57 Washington-Arlington-Alexandria, DC-VA-MD-WV 57 Wichita, KS 58 Worcester, MA 58 Youngstown-Warren-Boardman, OH-PA 59

DMEPOS Competitive Bidding Bid Preparation Worksheet - Round 2 & Bid Calculations This worksheet is provided to assist you with determining your bid amount and estimated capacity for each item in category. This information will be entered in DBidS, the online bidding system, on Form B. capacity is the estimated number of units that you believe you can provide competitive bidding area in a calendar year. All bid amounts must be bona fide (rational and feasible for you to furnish at the bid price). You must not submit a bid for an item at a loss in order to improve your chances of winning a contract. It is important for you to consider and include your cost to purchase the item, profit when determining a bid amount for a unit. CMS will evaluate bids to verify that they are bona fide and may ask you to submit additional information, including a rationale and invoices or other documents, to validate the bid amount. Save a copy of your completed worksheet to use if CMS requests documentation to support your bid amount. Please review the Request for Bids (RFB) instructions and fact sheets for assistance with completing your bid sheet (Form B). General Notes * The bidding units defined in this worksheet are for bidding purposes ONLY. Please carefully review the definition of a bidding unit for each (Healthcare Common Procedure Coding System) code and make sure you submit your bid amount correctly. Do NOT submit a rental bid amount when the definition of the bidding unit is for the purchase of a new item. The definition of a bidding unit (purchase or rental) is not necessarily an indication that this is how payment will be made for the item under the competitive bidding program. * In all situations where a competitive bidding area (CBA) covers more than one state, the fee schedule amount for the state with the highest allowed charges (the Medicare approved amount paid for an item) for items subject to competitive bidding is used as the bid limit. * may exceed because the beneficiary used the item for less than 10 months. (For bidding purposes, 10 months of rental are calculated as one unit). * Items that are currently paid on a monthly rental basis will continue to be paid on a monthly rental basis under the competitive bidding program. How Bids Will Be Converted to Rental Payments * Capped Rental Durable Medical Equipment (DME) except power wheelchairs - single payment amount for rental months 1-3 based on 10 percent of purchase bids and single payment amount for rental months 4-13 based on 7.5 percent of purchase bids * Power Wheelchairs - single payment amount for rental months 1-3 based on 15 percent of purchase bids and single payment amount for rental months 4-13 based on 6 percent of purchase bids * Enteral Nutrition Equipment - single payment amount for rental months 1-3 based on 10 percent of purchase bids and single payment amount for rental months 4-15 based on 7.5 percent of purchase bids * Inexpensive or Routinely d (IRP) DME - single payment amount for rental based on 10 percent of purchase of bids The order in which codes are presented in this worksheet is NOT NECESSARILY the order in which they will appear in Form B in DBidS. It is important that you CAREFULLY REVIEW THE DATA YOU ENTER IN DBIDS FOR ACCURACY. Product Category: Oxygen Supplies and Equipment Reference Data for Background Informational Purposes Only Reference Data for Background Informational Purposes Only Bidder Data (You will enter your estimated capacity and bid amount information in DBidS on Form B) CBA Name in CY units Cost to Bid a Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) Stationary Liquid Oxygen System, Rental; Includes Container, Contents, Regulator, Flowmeter, Oxygen Concentrator, Dual Delivery Port, Capable Of Delivering 85 Percent Or Greater, Each Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.5846261292 2,970 21,938 $176.06 The and are combined estimated capacity that includes all codes and a single bid amount that includes all One (1) month's rental 0.3037490208 1,651 11,430 $29.43 Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Akron, OH Portable Gaseous Oxygen System, Rental; Includes Portable Container, Regulator, Flowmeter, Humidifier, Cannula Or Mask, Payment Class C - Oxygen Generating Portable Equipment Only Portable Gaseous Oxygen System, Rental; Home Compressor Used To Fill Portable Oxygen Cylinders; Includes Portable Containers, Regulator, Flowmeter, Humidifier, Cannula Or Mask, Portable Liquid Oxygen System, Rental; Home Liquefier Used To Fill Portable Liquid Oxygen Containers, Includes Portable Containers, Regulator, Flowmeter, Humidifier, Cannula Or Mask Payment Class D - Stationary Oxygen Contents Only for each code codes in the One (1) month's rental 0.0467254172 392 2,936 $51.63 The and are combined estimated capacity that includes all codes and a single bid amount that includes all One (1) month's rental 0.0106179450 57 435 $77.45 Akron, OH E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Akron, OH E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Akron, OH Payment Class E - Portable Oxygen Contents Only Akron, OH E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Akron, OH E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit for each code codes in the One (1) month's rental 0.0542814878 267 1,822 $77.45 for each code codes in the

in CY units Cost to Bid a Albany-Schenectady-Troy, NY Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,368 25,450 $176.06 Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY for each code CS codes Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,108 14,783 $29.43 Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY Humidifier, Cannula Or Mask, The is combine d for each code estimated capacity that includes all codes and a single bid amount th at includes all codes Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 143 1,578 $51.63 CS codes Albany-Schenectady-Troy, NY Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 22 207 $77.45 Albany-Schenectady-Troy, NY E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Albany-Schenectady-Troy, NY E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Albany-Schenectady-Troy, NY Albany-Schenectady-Troy, NY E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Albany-Schenectady-Troy, NY E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 394 2,652 $77.45 for each code CS codes paymen t class e stimated capacity that includes all codes and a single bid amount that includes all codes Albuquerque, NM Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 4,436 33,083 $176.06 Albuquerque, NM Albuquerque, NM Albuquerque, NM Albuquerque, NM Albuquerque, NM Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,784 20,231 $29.43 Albuquerque, NM Albuquerque, NM Humidifier, Cannula Or Mask, The is combine d for each code e stimated capacity that includes all codes and a single bid amount that includes all co des Albuquerque, NM Albuquerque, NM Albuquerque, NM Albuquerque, NM Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 131 1,148 $51.63 Albuquerque, NM Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 127 1,188 $77.45 Albuquerque, NM E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Albuquerque, NM E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit

in CY units Cost to Bid a Albuquerque, NM Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 589 5,297 $77.45 Albuquerque, NM E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Albuquerque, NM E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes codes Allentown-Bethlehem-Easton, PA-NJ Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,311 24,504 $176.06 Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ The C ount and are combined Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Allentown-Bethlehem-Easton, PA-NJ Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,093 14,792 $29.43 Humidifier, Cannula Or Mask, CS c odes paymen t class e stimated capacity that includes all codes and a single bid amount that includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 255 2,391 $51.63 The is the sam e for each code The C ount and are combined Allentown-Bethlehem-Easton, PA-NJ Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 20 122 $77.45 Allentown-Bethlehem-Easton, PA-NJ E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit are combined for all H CPCS codes estimated capacity that includes all codes in t he and a single bid amount that includes all Allentown-Bethlehem-Easton, PA-NJ E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Allentown-Bethlehem-Easton, PA-NJ Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 245 1,824 $77.45 Allentown-Bethlehem-Easton, PA-NJ E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Allentown-Bethlehem-Easton, PA-NJ E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Asheville, NC Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 4,806 37,692 $176.06 Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Asheville, NC Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,297 18,813 $29.43 Humidifier, Cannula Or Mask, e stimated capacity that includes all codes and a single bid amount that includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 255 2,283 $51.63 are combined for all HC PCS codes

Bid Cost to CBA Name units a in CY Asheville, NC Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 83 664 $77.45 Asheville, NC E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Asheville, NC E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Asheville, NC Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 481 3,856 $77.45 Asheville, NC E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes Asheville, NC E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Atlanta-Sandy Springs-Marietta, GA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 13,784 100,388 $176.06 Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 8,369 59,422 $29.43 Atlanta-Sandy Springs-Marietta, GA Humidifier, Cannula Or Mask, Atlanta-Sandy Springs-Marietta, GA codes Atlanta-Sandy Springs-Marietta, GA Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 1,572 12,377 $51.63 Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 147 1,141 $77.45 Atlanta-Sandy Springs-Marietta, GA Atlanta-Sandy Springs-Marietta, GA E0442 E0441 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Atlanta-Sandy Springs-Marietta, GA Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 1,456 11,610 $77.45 Atlanta-Sandy Springs-Marietta, GA E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Atlanta-Sandy Springs-Marietta, GA E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Augusta-Richmond y, GA-SC Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 2,357 17,655 $176.06 Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,402 9,993 $29.43 Augusta-Richmond y, GA-SC Humidifier, Cannula Or Mask, Augusta-Richmond y, GA-SC codes

Bid Cost to CBA Name units a in CY Augusta-Richmond y, GA-SC Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 71 920 $51.63 Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 9 72 $77.45 Augusta-Richmond y, GA-SC E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Augusta-Richmond y, GA-SC E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Augusta-Richmond y, GA-SC Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 255 1,682 $77.45 Augusta-Richmond y, GA-SC Augusta-Richmond y, GA-SC E0443 E0444 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Austin-Round Rock-San Marcos, TX Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 5,099 38,121 $176.06 Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,357 16,949 $29.43 Austin-Round Rock-San Marcos, TX Humidifier, Cannula Or Mask, Austin-Round Rock-San Marcos, TX codes Austin-Round Rock-San Marcos, TX Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 599 5,478 $51.63 Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Austin-Round Rock-San Marcos, TX Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 67 480 $77.45 Austin-Round Rock-San Marcos, TX E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Austin-Round Rock-San Marcos, TX E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Austin-Round Rock-San Marcos, TX Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 524 3,532 $77.45 Austin-Round Rock-San Marcos, TX E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Austin-Round Rock-San Marcos, TX E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Bakersfield-Delano, CA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,753 29,133 $176.06 Bakersfield-Delano, CA Bakersfield-Delano, CA Bakersfield-Delano, CA Bakersfield-Delano, CA

in CY units Cost to Bid a Bakersfield-Delano, CA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,255 9,392 $29.43 Bakersfield-Delano, CA Bakersfield-Delano, CA Humidifier, Cannula Or Mask, for each code CS c odes paymen t class e stimated capacity that includes all codes and a single bid amount that includes all codes Bakersfield-Delano, CA Bakersfield-Delano, CA Bakersfield-Delano, CA Bakersfield-Delano, CA Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 88 718 $51.63 Bakersfield-Delano, CA Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 47 402 $77.45 Bakersfield-Delano, CA E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Bakersfield-Delano, CA E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Bakersfield-Delano, CA Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 238 1,650 $77.45 Bakersfield-Delano, CA E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Bakersfield-Delano, CA E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Baltimore-Towson, MD Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 9,921 73,816 $176.06 Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD CS codes Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD Baltimore-Towson, MD Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 6,523 47,525 $29.43 Humidifier, Cannula Or Mask, for each code CS c odes paymen t class e stimated capacity that includes all codes and a single bid amount that includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 1,639 11,925 $51.63 are combined for all HC PCS codes Baltimore-Towson, MD Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 175 1,362 $77.45 Baltimore-Towson, MD E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit for each code e stimated capacity that includes all codes and a single bid amount that includes all codes Baltimore-Towson, MD E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Baltimore-Towson, MD Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 1,171 9,026 $77.45 Baltimore-Towson, MD E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Baltimore-Towson, MD E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes

in CY units Cost to Bid a Baton Rouge, LA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 1,880 13,837 $176.06 Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA CS codes Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA Baton Rouge, LA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,133 8,043 $29.43 Humidifier, Cannula Or Mask, for each code CS c odes paymen t class e stimated capacity that includes all codes and a single bid amount that includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 109 959 $51.63 are combined for all HC PCS codes Baton Rouge, LA Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 11 61 $77.45 Baton Rouge, LA E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit are combined for all HC PCS codes Baton Rouge, LA E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Baton Rouge, LA Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 157 995 $77.45 Baton Rouge, LA E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Baton Rouge, LA E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Beaumont-Port Arthur, TX Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 1,907 15,250 $176.06 Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX are combined for all HC PCS codes Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,329 10,559 $29.43 Humidifier, Cannula Or Mask, The is combine d for each code CS c odes estimated capacity that includes all codes pa yment class and a single bid amount th at includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 90 736 $51.63 CS codes Beaumont-Port Arthur, TX Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 35 252 $77.45 Beaumont-Port Arthur, TX E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Beaumont-Port Arthur, TX E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit

Bid Cost to CBA Name units a in CY Beaumont-Port Arthur, TX Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 214 1,329 $77.45 Beaumont-Port Arthur, TX Beaumont-Port Arthur, TX E0443 E0444 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Birmingham-Hoover, AL Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,597 26,794 $176.06 Birmingham-Hoover, AL Birmingham-Hoover, AL Birmingham-Hoover, AL Birmingham-Hoover, AL Birmingham-Hoover, AL Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,047 16,481 $29.43 Birmingham-Hoover, AL Humidifier, Cannula Or Mask, Birmingham-Hoover, AL codes Birmingham-Hoover, AL Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 302 2,261 $51.63 Birmingham-Hoover, AL Birmingham-Hoover, AL Birmingham-Hoover, AL Birmingham-Hoover, AL Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 44 332 $77.45 Birmingham-Hoover, AL E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Birmingham-Hoover, AL E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Birmingham-Hoover, AL Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 272 2,509 $77.45 Birmingham-Hoover, AL E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Birmingham-Hoover, AL E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Boise City-Nampa, ID Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 1,760 17,992 $176.06 Boise City-Nampa, ID Boise City-Nampa, ID Boise City-Nampa, ID Boise City-Nampa, ID Boise City-Nampa, ID Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 929 11,195 $29.43 Boise City-Nampa, ID Humidifier, Cannula Or Mask, Boise City-Nampa, ID codes Boise City-Nampa, ID Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 22 295 $51.63 Boise City-Nampa, ID Boise City-Nampa, ID Boise City-Nampa, ID

Bid Cost to CBA Name units a in CY Boise City-Nampa, ID Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 240 1,986 $77.45 Boise City-Nampa, ID E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Boise City-Nampa, ID E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Boise City-Nampa, ID Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 210 2,816 $77.45 Boise City-Nampa, ID E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Boise City-Nampa, ID E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Boston-Cambridge-Quincy, MA-NH Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 11,957 91,968 $176.06 Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 7,038 53,981 $29.43 Boston-Cambridge-Quincy, MA-NH Humidifier, Cannula Or Mask, Boston-Cambridge-Quincy, MA-NH codes Boston-Cambridge-Quincy, MA-NH Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 1,485 12,645 $51.63 Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 537 4,472 $77.45 Boston-Cambridge-Quincy, MA-NH E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Boston-Cambridge-Quincy, MA-NH E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Boston-Cambridge-Quincy, MA-NH Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 1,163 12,091 $77.45 Boston-Cambridge-Quincy, MA-NH Boston-Cambridge-Quincy, MA-NH E0443 E0444 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Bridgeport-Stamford-Norwalk, CT Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 2,491 17,667 $176.06 Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,140 8,189 $29.43 Bridgeport-Stamford-Norwalk, CT Humidifier, Cannula Or Mask, Bridgeport-Stamford-Norwalk, CT codes

in CY units Cost to Bid a Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Bridgeport-Stamford-Norwalk, CT Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 805 5,163 $51.63 Bridgeport-Stamford-Norwalk, CT Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 28 243 $77.45 Bridgeport-Stamford-Norwalk, CT E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Bridgeport-Stamford-Norwalk, CT E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Bridgeport-Stamford-Norwalk, CT Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 203 1,439 $77.45 Bridgeport-Stamford-Norwalk, CT E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Bridgeport-Stamford-Norwalk, CT E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Bronx-Manhattan NY CBA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,171 21,947 $176.06 Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Bronx-Manhattan NY CBA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,082 14,474 $29.43 Humidifier, Cannula Or Mask, estimated capacity that includes all codes pa yment class and a single bid amount that includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 468 3,798 $51.63 Bronx-Manhattan NY CBA Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 22 128 $77.45 Bronx-Manhattan NY CBA E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Bronx-Manhattan NY CBA E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit CS codes Bronx-Manhattan NY CBA Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 271 1,610 $77.45 Bronx-Manhattan NY CBA E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Bronx-Manhattan NY CBA E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Buffalo-Niagara Falls, NY Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 4,176 33,111 $176.06 Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY

Bid Cost to CBA Name units a in CY Buffalo-Niagara Falls, NY Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,305 17,705 $29.43 Buffalo-Niagara Falls, NY Humidifier, Cannula Or Mask, Buffalo-Niagara Falls, NY codes Buffalo-Niagara Falls, NY Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 186 1,518 $51.63 Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 77 661 $77.45 Buffalo-Niagara Falls, NY Buffalo-Niagara Falls, NY E0442 E0441 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Buffalo-Niagara Falls, NY Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 363 2,715 $77.45 Buffalo-Niagara Falls, NY E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes Buffalo-Niagara Falls, NY E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Cape Coral-Fort Myers, FL Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,601 25,901 $176.06 Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,909 12,907 $29.43 Cape Coral-Fort Myers, FL Humidifier, Cannula Or Mask, Cape Coral-Fort Myers, FL codes Cape Coral-Fort Myers, FL Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 84 1,035 $51.63 Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Cape Coral-Fort Myers, FL Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 20 116 $77.45 Cape Coral-Fort Myers, FL E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Cape Coral-Fort Myers, FL E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Cape Coral-Fort Myers, FL Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 239 1,451 $77.45 Cape Coral-Fort Myers, FL E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes Cape Coral-Fort Myers, FL E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit

Bid Cost to CBA Name units a in CY Central-Chicago Metro CBA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 20,750 152,203 $176.06 Central-Chicago Metro CBA Central-Chicago Metro CBA Central-Chicago Metro CBA Central-Chicago Metro CBA Central-Chicago Metro CBA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 12,429 89,243 $29.43 Central-Chicago Metro CBA Humidifier, Cannula Or Mask, Central-Chicago Metro CBA codes Central-Chicago Metro CBA Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 2,642 18,903 $51.63 Central-Chicago Metro CBA Central-Chicago Metro CBA Central-Chicago Metro CBA Central-Chicago Metro CBA Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 294 2,087 $77.45 Central-Chicago Metro CBA Central-Chicago Metro CBA E0442 E0441 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Central-Chicago Metro CBA Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 1,498 11,948 $77.45 Central-Chicago Metro CBA E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Central-Chicago Metro CBA E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Charleston-North Charleston-Summerville, SC Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 2,710 20,728 $176.06 Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,334 9,940 $29.43 Charleston-North Charleston-Summerville, SC Humidifier, Cannula Or Mask, Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 213 1,837 $51.63 Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Charleston-North Charleston-Summerville, SC Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 16 134 $77.45 Charleston-North Charleston-Summerville, SC E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Charleston-North Charleston-Summerville, SC E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit

in CY units Cost to Bid a Charleston-North Charleston-Summerville, SC Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 234 1,493 $77.45 Charleston-North Charleston-Summerville, SC E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Charleston-North Charleston-Summerville, SC E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit for each code are combined estimated capacity that includes all codes and a single bid amount th at includes all codes Chattanooga, TN-GA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,983 30,749 $176.06 Chattanooga, TN-GA Chattanooga, TN-GA Chattanooga, TN-GA Chattanooga, TN-GA Chattanooga, TN-GA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,327 17,799 $29.43 Chattanooga, TN-GA Chattanooga, TN-GA Humidifier, Cannula Or Mask, for each code are combined for all c odes estimated capacity that includ es all codes and a s ingle bid amount th at includes all codes Chattanooga, TN-GA Chattanooga, TN-GA Chattanooga, TN-GA Chattanooga, TN-GA Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 56 541 $51.63 The is combin ed CS codes Chattanooga, TN-GA Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 26 218 $77.45 Chattanooga, TN-GA E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Chattanooga, TN-GA E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Chattanooga, TN-GA Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 409 3,092 $77.45 Chattanooga, TN-GA E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Chattanooga, TN-GA E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Colorado Springs, CO Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 6,860 53,835 $176.06 Colorado Springs, CO Colorado Springs, CO Colorado Springs, CO Colorado Springs, CO CS codes Colorado Springs, CO Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 3,366 26,147 $29.43 Colorado Springs, CO Colorado Springs, CO Humidifier, Cannula Or Mask, for each code are combined for all c odes estimated capacity that includ es all codes and a s ingle bid amount th at includes all codes Colorado Springs, CO Colorado Springs, CO Colorado Springs, CO Colorado Springs, CO Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 451 2,992 $51.63

in CY units Cost to Bid a Colorado Springs, CO Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 221 1,970 $77.45 Colorado Springs, CO E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Colorado Springs, CO E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit CS codes Colorado Springs, CO Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 887 8,420 $77.45 Colorado Springs, CO E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Colorado Springs, CO E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Columbia, SC Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 2,860 22,090 $176.06 Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Columbia, SC Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,335 9,740 $29.43 Humidifier, Cannula Or Mask, for each code are combined estimated capacity that includ es all codes and a s ingle bid amount th at includes all codes Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 215 1,771 $51.63 for all codes in t he CS codes Columbia, SC Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 9 64 $77.45 Columbia, SC E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit CS codes Columbia, SC E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Columbia, SC Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 219 1,477 $77.45 Columbia, SC E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Columbia, SC E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit The and are combined for all HCP CS codes Columbus, OH Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 5,752 43,244 $176.06 Columbus, OH Columbus, OH Columbus, OH Columbus, OH Columbus, OH Columbus, OH Columbus, OH Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 3,544 25,706 $29.43 Humidifier, Cannula Or Mask, The is combine d are combined codes

Bid Cost to CBA Name units a in CY Columbus, OH Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 92 1,071 $51.63 Columbus, OH Columbus, OH Columbus, OH Columbus, OH Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 47 372 $77.45 Columbus, OH Columbus, OH E0442 E0441 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Columbus, OH Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 729 4,880 $77.45 Columbus, OH E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes Columbus, OH E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Dayton, OH Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 4,050 31,547 $176.06 Dayton, OH Dayton, OH Dayton, OH Dayton, OH Dayton, OH Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,078 15,242 $29.43 Dayton, OH Humidifier, Cannula Or Mask, Dayton, OH codes Dayton, OH Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 369 2,940 $51.63 Dayton, OH Dayton, OH Dayton, OH Dayton, OH Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 30 251 $77.45 Dayton, OH E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Dayton, OH E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Dayton, OH Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 423 2,768 $77.45 Dayton, OH Dayton, OH E0443 E0444 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Deltona-Daytona Beach-Ormond Beach, FL Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 2,785 19,951 $176.06 Deltona-Daytona Beach-Ormond Beach, FL Deltona-Daytona Beach-Ormond Beach, FL Deltona-Daytona Beach-Ormond Beach, FL Deltona-Daytona Beach-Ormond Beach, FL

Bid Cost to CBA Name units a in CY Deltona-Daytona Beach-Ormond Beach, FL Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,256 8,877 $29.43 Deltona-Daytona Beach-Ormond Beach, FL Humidifier, Cannula Or Mask, Deltona-Daytona Beach-Ormond Beach, FL codes Deltona-Daytona Beach-Ormond Beach, FL Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 254 2,079 $51.63 Deltona-Daytona Beach-Ormond Beach, FL Deltona-Daytona Beach-Ormond Beach, FL Deltona-Daytona Beach-Ormond Beach, FL Deltona-Daytona Beach-Ormond Beach, FL Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 28 224 $77.45 Deltona-Daytona Beach-Ormond Beach, FL E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Deltona-Daytona Beach-Ormond Beach, FL E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Deltona-Daytona Beach-Ormond Beach, FL Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 177 1,327 $77.45 Deltona-Daytona Beach-Ormond Beach, FL E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes Deltona-Daytona Beach-Ormond Beach, FL E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Denver-Aurora-Broomfield, CO Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 12,988 108,591 $176.06 Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 4,964 50,127 $29.43 Denver-Aurora-Broomfield, CO Humidifier, Cannula Or Mask, Denver-Aurora-Broomfield, CO codes Denver-Aurora-Broomfield, CO Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 1,796 11,691 $51.63 Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Denver-Aurora-Broomfield, CO Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 1,002 8,407 $77.45 Denver-Aurora-Broomfield, CO E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Denver-Aurora-Broomfield, CO E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Denver-Aurora-Broomfield, CO Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 1,110 14,475 $77.45 Denver-Aurora-Broomfield, CO E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes Denver-Aurora-Broomfield, CO E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit

Bid Cost to CBA Name units a in CY Detroit-Warren-Livonia, MI Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 21,672 160,714 $176.06 Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 14,868 105,104 $29.43 Detroit-Warren-Livonia, MI Humidifier, Cannula Or Mask, Detroit-Warren-Livonia, MI codes Detroit-Warren-Livonia, MI Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 2,431 21,038 $51.63 Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Detroit-Warren-Livonia, MI Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 191 1,505 $77.45 Detroit-Warren-Livonia, MI E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Detroit-Warren-Livonia, MI E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Detroit-Warren-Livonia, MI Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 1,756 11,918 $77.45 Detroit-Warren-Livonia, MI E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Detroit-Warren-Livonia, MI E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit El Paso, TX Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,247 24,636 $176.06 El Paso, TX El Paso, TX El Paso, TX El Paso, TX El Paso, TX Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,114 16,051 $29.43 El Paso, TX Humidifier, Cannula Or Mask, El Paso, TX codes El Paso, TX Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 134 1,702 $51.63 El Paso, TX El Paso, TX El Paso, TX El Paso, TX Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 164 1,387 $77.45 El Paso, TX E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit El Paso, TX E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit

Bid Cost to CBA Name units a in CY El Paso, TX Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 415 3,851 $77.45 El Paso, TX E0443 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit codes El Paso, TX E0444 Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Flint, MI Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 3,109 23,181 $176.06 Flint, MI Flint, MI Flint, MI Flint, MI Flint, MI Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 2,012 13,951 $29.43 Flint, MI Humidifier, Cannula Or Mask, Flint, MI codes Flint, MI Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 234 1,795 $51.63 Flint, MI Flint, MI Flint, MI Flint, MI Payment Class D - Stationary Oxygen Contents Only One (1) month's rental 0.0106179450 17 107 $77.45 Flint, MI E0442 Stationary Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit codes Flint, MI E0441 Stationary Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Flint, MI Payment Class E - Portable Oxygen Contents Only One (1) month's rental 0.0542814878 311 1,843 $77.45 Flint, MI Flint, MI E0443 E0444 Portable Oxygen Contents, Gaseous, 1 Month's Supply = 1 Unit Portable Oxygen Contents, Liquid, 1 Month's Supply = 1 Unit Fresno, CA Payment Class A - Stationary Oxygen Equipment & Oxygen Contents (Stationary & Portable) One (1) month's rental 0.5846261292 4,056 32,092 $176.06 Fresno, CA Fresno, CA Fresno, CA Fresno, CA Fresno, CA Payment Class B - Portable Equipment Only (Gaseous or Liquid Tanks) One (1) month's rental 0.3037490208 1,221 8,847 $29.43 Fresno, CA Humidifier, Cannula Or Mask, Fresno, CA codes Fresno, CA Payment Class C - Oxygen Generating Portable Equipment Only One (1) month's rental 0.0467254172 244 2,548 $51.63 Fresno, CA Fresno, CA Fresno, CA

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