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1. EXHIBIT 4.1 Costs for the Most Frequent Diagnoses
   hcup-us.ahrq.gov/reports/factsandfigures/figures/2005/2005_4_1A.jsp
   January 01, 2005 - Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones … Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones

2. Depression
   hcup-us.ahrq.gov/reports/factsandfigures/figures/2006/2006_5_2b.jsp
   January 01, 2006 - complications 5% 16% Thyroid disorders 4% 12% Disorders of intervertebral discs and bones

3. Briefintrotoicd-10Codes041117 (pdf file)
   hcup-us.ahrq.gov/datainnovations/BriefIntrotoICD-10Codes041117.pdf
   April 11, 2017 - Subcutaneous Tissue & Fascia, (K) Muscles, (L) Tendons, (M) Bursae & Ligaments, (N) Head & Facial Bones … , (P) Upper Bones, (Q) Lower Bones, (R) Upper Joints, (S) Lower Joints, (T) Urinary System, (U) Female … Description ICD-10-PCS Description ICD Codes 01.25 Other craniectomy 0NT80ZZ Resection of left occipital bone … nervous system First two code characters 0N Medical and Surgical section of Head and Facial Bones … Corresponding CCS Category 1 Incision and excision of CNS 161 Other OR therapeutic procedure on bone

4. Slide 1 (pdf file)
   hcup-us.ahrq.gov/datainnovations/ICD10Imp_Romano_NAHDO_October2016.pdf
   October 27, 2016 - pressure from the spinal cord, assign a code from table 0QB or 0PB: – Laminectomy • see Excision, Lower Bones … 0QB- • see Excision, Upper Bones 0PB- • AHA Coding Clinic, 2Q 2015, 2(2):34 – “Decompressive laminectomy … • Currently maps to body systems R (upper joints) and S (lower joints)… but what about P (upper bones … ) and Q (lower bones)?

5. Exhibit 2.3 Most Frequent Diagnoses by Sex
   hcup-us.ahrq.gov/reports/factsandfigures/figures/2005/2005_2_3.jsp
   January 01, 2005 - Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones

6. PRCCSR-ChangeLog-v20211-v20221 (xls file)
   hcup-us.ahrq.gov/toolssoftware/ccsr/PRCCSR-ChangeLog-v20211-v20221.xlsx
   October 01, 2021 - Void Filler into Bones, Open Approach, New Technology Group 7 ADM015 Administration of antibiotics … Bone marrow aspiration (therapeutic) 07DT3ZZ Extraction of Bone Marrow, Percutaneous Approach LYM008 … (s) 1st Toe, Open Approach MST018 Bone excision 0QBN3Z2 Excision of Right Metatarsal, Sesamoid Bone( … , Sesamoid Bone(s) 1st Toe, Open Approach MST018 Bone excision 0QBP3Z2 Excision of Left Metatarsal, … , Sesamoid Bone(s) 1st Toe, Percutaneous Endoscopic Approach MST018 Bone excision 0NH003Z Insertion

7. PRCCSR ChangeLog v20221 v20231 (xls file)
   hcup-us.ahrq.gov/toolssoftware/ccsr/PRCCSR-ChangeLog-v20231-v20241.xlsx
   December 01, 2023 - Cervical Vertebra using Laser Interstitial Thermal Therapy, Percutaneous Endoscopic Approach 'MST018' Bone … Lumbar Vertebra using Laser Interstitial Thermal Therapy, Percutaneous Endoscopic Approach 'MST018' Bone … 'CAR026' Pacemaker and defibrillator procedures 302A3H0 Transfusion of Autologous Whole Blood into Bone … Transfusion of blood and blood products 302A3N1 Transfusion of Nonautologous Red Blood Cells into Bone … Transfusion of blood and blood products 302A3P1 Transfusion of Nonautologous Frozen Red Cells into Bone

8. Section5 8 (pdf file)
   hcup-us.ahrq.gov/reports/factsandfigures/2007/pdfs/section5_8.pdf
   January 01, 2007 - Osteoarthritis (degenerative joint disease) 279 455 43.3 48.4 63 Disorders of intervertebral discs and bones

9. Section5 9 (pdf file)
   hcup-us.ahrq.gov/reports/factsandfigures/2007/pdfs/section5_9.pdf
   January 01, 2007 - degenerative joint disease) 8 19 10.5 17.5 137 Disorders of intervertebral discs and bones

10. Differences in Hospital Stays With Operating Room Procedures by Patient Race and Ethnicity, 2019 (pdf file)
    hcup-us.ahrq.gov/reports/statbriefs/sb297-OR-procedures-racial-disparities-2019.pdf
    January 01, 2019 - and other therapeutic heart procedures 16.7 13.2 15.8 11.8 15.4 9 Fixation of upper extremity bones … Gastrectomy 64.3 9.6 100.3 57.3 60.8 3 Appendectomy 51.0 28.9 38.8 63.7 47.0 4 Fixation of leg and foot bones …  White NH children had the highest rate of stays with bone fixation, spine fusion, bone excision, … upper gastrointestinal therapeutic procedures, and fixation of upper extremity bones. … years  Black NH adults had the highest rate of stays with gastrectomy, fixation of leg and foot bones

11. Change Log (v2024.1 to v2025.1) for the Clinical Classifications Software Refined (CCSR) for ICD-10-PCS (xls file)
    hcup-us.ahrq.gov/toolssoftware/ccsr/PRCCSR-ChangeLog-v20241-v20251.xlsx
    November 01, 2024 - from Nasal Bone, Percutaneous Approach MST012 Bone fixation (excluding extremities) 0NPB45Z Removal … of External Fixation Device from Nasal Bone, Percutaneous Endoscopic Approach MST012 Bone fixation ( … Device from Facial Bone, Percutaneous Approach MST012 Bone fixation (excluding extremities) 0NPW45Z … Facial Bone, Percutaneous Approach MST012 Bone fixation (excluding extremities) 0NWW45Z Revision of … Void Filler into Bones, Percutaneous Approach, New Technology Group 10 ADM021 Administration of therapeutic

12. PC-ICD10PCSChgLg-v20212-v20221 (xls file)
    hcup-us.ahrq.gov/toolssoftware/procedureicd10/PClassR-ChangeLg-v20212-v20221.xlsx
    December 01, 2022 - Marrow, Open Approach, Diagnostic 1 Minor Diagnostic 07DT0ZZ Extraction of Bone Marrow, Open Approach … (s) 1st Toe, Open Approach 4 Major Therapeutic 0QBN3Z2 Excision of Right Metatarsal, Sesamoid Bone(s … (s) 1st Toe, Open Approach 4 Major Therapeutic 0QBP3Z2 Excision of Left Metatarsal, Sesamoid Bone(s) … 1st Toe, Percutaneous Approach 4 Major Therapeutic 0QBP4Z2 Excision of Left Metatarsal, Sesamoid Bone … Void Filler into Bones, Open Approach, New Technology Group 7 4 Major Therapeutic XW133D7 Transfusion

13. Exhibit 2.2. Most Frequent Diagnoses by Age
    hcup-us.ahrq.gov/reports/factsandfigures/figures/2005/2005_2_2.jsp
    January 01, 2005 - Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones

14. PRCCSR-ChangeLog-v20221-v20231 (xls file)
    hcup-us.ahrq.gov/toolssoftware/ccsr/PRCCSR-ChangeLog-v20221-v20231.xlsx
    November 01, 2022 - Administration of therapeutic substances, NEC 3E0V0GC Introduction of Other Therapeutic Substance into Bones … Administration of therapeutic substances, NEC 3E0V4GC Introduction of Other Therapeutic Substance into Bones … of Internal Fixation Device with Tulip Connector into Right Pelvic Bone, Percutaneous Approach, New … Device with Tulip Connector into Left Pelvic Bone, Open Approach, New Technology Group 8 MST012 Bone … , Percutaneous Approach, New Technology Group 8 MST012 Bone fixation (excluding extremities) XRGE058

15. Exhibit 2.1. Most Frequent Principal Diagnoses
    hcup-us.ahrq.gov/reports/factsandfigures/figures/2005/2005_2_1.jsp
    January 01, 2005 - Spondylosis, intervertebral disc disorders, other back problems (disorders of intervertebral discs and bones

16. PClassR Change Log v20231-v20241 (xls file)
    hcup-us.ahrq.gov/toolssoftware/procedureicd10/PClassR-ChangeLog-v20231-v20241.xlsx
    April 01, 2024 - Percutaneous Approach 2 Minor Therapeutic 302A3J1 Transfusion of Nonautologous Serum Albumin into Bone … Percutaneous Approach 2 Minor Therapeutic 302A3K1 Transfusion of Nonautologous Frozen Plasma into Bone … , Percutaneous Approach 2 Minor Therapeutic 302A3L1 Transfusion of Nonautologous Fresh Plasma into Bone … , Percutaneous Approach 2 Minor Therapeutic 302A3N0 Transfusion of Autologous Red Blood Cells into Bone … Percutaneous Approach 2 Minor Therapeutic 302A3P0 Transfusion of Autologous Frozen Red Cells into Bone

17. Section4 2 (pdf file)
    hcup-us.ahrq.gov/reports/factsandfigures/2007/pdfs/section4_2.pdf
    January 01, 2007 - 9.5 5.8 47.0 Disorders of intervertebral discs and bones

18. Exhibit 3.6. Orthopedic Procedures
    hcup-us.ahrq.gov/reports/factsandfigures/figures/2005/2005_3_6C.jsp
    January 01, 2005 - 7,200 198,400 596,200 1,114,000 1,225,500 251,300 142 Partial excision of bone … procedures 100.0 100.0 100.0 100.0 100.0 100.0 100.0 142 Partial excision of bone … 99,097 1,121 23,958 26,050 38,548 40,028 7,204 142 Partial excision of bone

19. Statistical Brief #24
    hcup-us.ahrq.gov/reports/statbriefs/sb24.jsp
    January 01, 2007 - (a hole between the two larger chambers of the heart), congenital anomalies of the skull and facial bones … 3.6 $12,500 $26,930,200 28.6% 27.4 0.0% Congenital anomalies of skull and facial bones … 11 Hypospadias and epispadias 18,100 12 Congenital anomalies of skull and facial bones

20. HCUP Statistical Brief #24: Hospitalizations for Birth Defects, 2004 (pdf file)
    hcup-us.ahrq.gov/reports/statbriefs/sb24.pdf
    January 01, 2007 - a hole between the two larger chambers of the heart), congenital anomalies of the skull and facial bones … deformity 2,200 1.5% 3.6 $12,500 $26,930,200 28.6% 27.4 0.0% Congenital anomalies of skull and facial bones … epispadias 18,100 12 Congenital anomalies of skull and facial bones