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improvements thereon or portion thereof to be used by Tenant or any occupant or tenant thereof (other than Landlord or its affiliate which may lease space in the MOB from time to time) for the following services without the express prior written approval of Landlord, which approval, except as otherwise provided in the Lease, shall be at the sole discretion of Landlord and may be withheld for any reason, reasonable or unreasonable, or for no reason at all: (i) ambulatory surgery procedures (as defined in the list of Medicare - covered ambulatory surgery procedures) or any other surgical or other procedures that require a general anesthetic (as opposed to only a local anesthetic); (ii) physical therapy; (iii) reference diagnostic imaging services (which include, without limitation, the following: fluoroscopy, computerized tomography (CT), radiation therapy, mammography and breast diagnostics, nuclear medicine testing, magnetic resonance imaging and positive emission tomography); (iv) cardiac catheterization; and (v) laboratory services, unless Landlord acknowledges in writing that laboratory services are not available to Tenant or such occupants on a commercially reasonable basis at the Hospital or any medically - related facility in Grand Island, Nebraska owned or operated by Landlord or an affiliate; provided, however, that Landlord's consent shall not be required for x -ray, plane film radiography and ultrasound services, and Landlord shall not otherwise unreasonably withhold approval with respect to any other services identified under subsections (i) through (v) above, with respect to tenants of the MOB or physician employees of such tenants performing x -ray, plane film radiography or ultrasound services or other services identified under subsections (i) through (v) as such services relate to their own patients where such tenants or physician employees of such tenants are the treating professionals and such services are provided incidental to any such tenants or physician employees of such tenants use of the MOB to the extent such services are customarily provided by a physician in the treatment of such physician's patients in the ordinary and customary course of treatment within a physician office setting, provided that such services (A) may be performed under applicable law in a physician office setting, (B) are merely ancillary and incidental to such physician's primary medical practice and do not constitute the physician's primary medical practice or specialty nor the predominant services rendered by such physician to such physician's patients and (C) such patients are not referred to such physician primarily for the purpose of obtaining such services. (b) ERD Restrictions. Landlord is an affiliate of Catholic Health Initiatives ( "CHI "), a Colorado nonprofit corporation, and the MOB is associated with the Hospital. As long as (i) the Hospital or the Hospital Operator are an affiliate of CHI, or (ii) the Land is owned, operated or managed by Landlord, or an affiliate of Landlord, or CHI, or any other entity subject to Canon Law of the Roman Catholic Church, the Leased Ground, or any part thereof leased hereunder (including, without limitation, the MOB), will at all times hereafter be used in a manner materially consistent with the Ethical and Religious Directives for Catholic Health Care Services, Fourth Edition, as promulgated by the United States Conference of Catholic Bishops, as amended from time to time, and as interpreted by the local bishop (the "ERDs "). The ERDs can be found at the following website: St. Francis Memorial Health Center, 2116 West Faidley Avenue, Grand Island Nebraska 53258573 201604408